Disparities in Medical Home Access for Children with Arthritis

Introduction: Patient-centered medical home models include comprehensive care tailored to individual needs by focusing on values and culture, coordinating services between caretakers, offering accessible services, and using evidence-based medical practices. Access to medical home care is correlated with increased preventative care, less unmet health and family support needs, and increased use of community-based services. This model can be used to evaluate disparities in the treatment of chronic illnesses like childhood arthritis. Thus, our objective was to assess rates of children with arthritis and their access to medical homes.

Methods: We conducted a cross-sectional analysis of the National Survey of Children's Health using data from the 2016-2021 cycles. Survey design and sampling weights, provided by the NSCH, were adjusted to account for multiple data cycles. First, we reported the sample prevalence and population estimate of children having arthritis in the United States. Then we assessed sociodemographic disparities among children with arthritis meeting medical home criteria.

Results: There were 560 (0.24%) children within the sample of 223,341 participants who had a current diagnosis of arthritis. Among children with arthritis, 30.5% had access to a medical home while 47.77% of children without arthritis had access to a medical home—a significant difference (OR: 0.48; 95%CI: 0.36-0.65). Children who were reported as white and also reported had a current arthritis diagnosis were more likely to be in a medical home when compared to children reporting as Black (OR: 0.27; 95% CI: 0.11-0.69), Hispanic (OR: 0.22; 95% CI: 0.08-0.5), or other minority groups (OR: 0.29; 95% CI: 0.1-0.84) respectively. Medical home access increased with increased adult educational attainment—which was statistically significant. Furthermore using 0%-99% of the federal poverty income as our reference, there was increased access to medical homes for children with arthritis and 100%-199%, 200%-399%, and 400%+ of the federal poverty level with odds ratios of 8.52 (95% CI: 3.01-0), 4.09 (95% CI: 1.57-0), and 5.13 (95% CI: 2.22-0), respectively. Associations between medical home access and neither metropolitan statistical area nor arthritis severity were statistically significant.

Conclusion: Upon evaluation of medical home access for children with arthritis, not only did we find that children with arthritis were significantly less likely to be in a medical home compared to children without arthritis, but we also found significant disparities within the sample of children with arthritis among ethnoracial groupings, parental educational attainment, and household income level. These sociodemographic disparities are common among most child groups, further research into factors influencing disparities is warranted to increase evidence-based interventions and resources. Conversely, no significant associations were found between medical home access and arthritis severity nor among rural areas—the latter of which is often noted as a difficult barrier to overcome for medical access.