Racial Disparities in Quality of Dental Care Among Publicly Insured Children

Background: Reducing oral health disparities requires identifying subgroups experiencing gaps in quality of dental care and the sizes of those gaps. This study measured magnitudes and trends of racial/ethnic disparities in overall quality of dental care and examined factors contributing to the disparities. Methods: This retrospective cohort study used claims data from beneficiaries under age 21 enrolled in Medicaid and Children’s Health Insurance Program in 6 states during 2015–2019. A standardized composite score of dental care quality was derived from 6 dental quality measures using Item Response Theory. Robust mixed-effect regression estimated the magnitudes and trends of quality disparities, adjusting for person-level covariates. A Blinder-Oaxaca decomposition quantified the relative contributions of the social and structural factors in the estimated racial/ethnic disparities. Results: Among 3.4 million beneficiaries, compared with White counterparts, Black children had lower baseline quality scores in 2 states and experienced decreases in quality in most states. Children of other race had lower baseline quality scores in 4 states with the largest gap of −0.16 (95% CI: −0.18,−0.15) and experienced decreases in quality in 3 states. Hispanic children had the higher baseline quality scores in all states with the largest gap of 0.34 (95% CI: 0.34,0.35) and experienced increases in quality in 4 states. Decomposition analysis indicated that structural factors, such as residential segregation, place of dental care, and dentist supply, explained portions of the quality gaps. Conclusion: Dental care quality was lower among Black and children of other race and higher among Hispanic and Asian children relative to their White counterparts. Tailored quality improvement efforts and refinements in Medicaid policy would be encouraged to reduce disparities in dental care and oral health.