Location
Philadelphia, PA
Start Date
17-4-2026 1:30 PM
End Date
17-4-2026 2:30 PM
Description
Introduction: Medication adherence is a fundamental driver of health outcomes among children with special healthcare needs (CSHN), as consistent medication use is essential for managing chronic and complex conditions. Disparities in medication adherence persist, particularly among children from different racial and ethnic groups, and are influenced by caregiver factors such as socioeconomic status, access to healthcare, and structural barriers. Large national surveys enable the tracking of medication adherence over time and help uncover ongoing disparities across populations. However, limited long-term evidence has examined whether racial and ethnic disparities in medication adherence among CSHN have narrowed. Therefore, this study aimed to: (1) evaluate national trends in poor medication adherence among CSHN from 2000 to 2018 using National Health Interview Survey (NHIS) data, and (2) assess whether disparities in adherence by caregiver race and ethnicity changed over time.
Methods: We examined a nationally representative sample of children aged 5–17 years with special healthcare needs who used medication, based on caregiver-reported data from the NHIS (2000–2018). The primary outcome was poor medication adherence, defined as caregiver-reported cost-related nonadherence, including inability to afford needed prescription medications and/or delayed medical care due to cost in the past 12 months. Age- and sex-adjusted percentages of poor adherence were calculated by caregiver race/ethnicity. Multivariate logistic regression was used to examine associations between race/ethnicity and survey periods.
Results: The prevalence of children classified as having special healthcare needs remained stable across survey periods (28%–30%), and among CSHN, the proportion using long-term prescription medication was also stable (approximately 10.7%–11.7%). Non-Hispanic Black and Hispanic children consistently exhibited higher rates of poor adherence compared to non-Hispanic White children. Over time, poor adherence declined by 21.3% among children of non-Hispanic White caregivers (p = 0.046); however, the decline was not statistically significant among children of non-Hispanic Black (p = 0.505) or Hispanic caregivers (p = 0.405). Logistic regression analysis showed that CSHN with non-Hispanic Black (OR 1.40, 95% CI 1.16–1.68) and Hispanic (OR 1.42, 95% CI 1.18–1.72) caregivers were more likely to experience poor medication adherence compared to those with non-Hispanic White caregivers. No significant interactions were observed between survey periods and caregiver race/ethnicity.
Discussion: Using nearly two decades of nationally representative data, this study found that racial and ethnic disparities in medication adherence among CSHN have remained largely unchanged. Although poor medication adherence declined modestly overall, these improvements were driven primarily by children of non-Hispanic White caregivers, with no statistically significant gains among children of non-Hispanic Black or Hispanic caregivers. These findings suggest that the underlying drivers of poor adherence remain persistent.
Conclusion: Despite modest overall improvements in medication adherence among CSHN, racial and ethnic disparities persist. These findings underscore the need for targeted interventions addressing socioeconomic barriers, healthcare access, and culturally tailored education to improve adherence and reduce longstanding inequities in this vulnerable population.
Embargo Period
6-4-2026
Included in
Racial/Ethnic Disparities in Medication Adherence Among Children with Special Healthcare Needs
Philadelphia, PA
Introduction: Medication adherence is a fundamental driver of health outcomes among children with special healthcare needs (CSHN), as consistent medication use is essential for managing chronic and complex conditions. Disparities in medication adherence persist, particularly among children from different racial and ethnic groups, and are influenced by caregiver factors such as socioeconomic status, access to healthcare, and structural barriers. Large national surveys enable the tracking of medication adherence over time and help uncover ongoing disparities across populations. However, limited long-term evidence has examined whether racial and ethnic disparities in medication adherence among CSHN have narrowed. Therefore, this study aimed to: (1) evaluate national trends in poor medication adherence among CSHN from 2000 to 2018 using National Health Interview Survey (NHIS) data, and (2) assess whether disparities in adherence by caregiver race and ethnicity changed over time.
Methods: We examined a nationally representative sample of children aged 5–17 years with special healthcare needs who used medication, based on caregiver-reported data from the NHIS (2000–2018). The primary outcome was poor medication adherence, defined as caregiver-reported cost-related nonadherence, including inability to afford needed prescription medications and/or delayed medical care due to cost in the past 12 months. Age- and sex-adjusted percentages of poor adherence were calculated by caregiver race/ethnicity. Multivariate logistic regression was used to examine associations between race/ethnicity and survey periods.
Results: The prevalence of children classified as having special healthcare needs remained stable across survey periods (28%–30%), and among CSHN, the proportion using long-term prescription medication was also stable (approximately 10.7%–11.7%). Non-Hispanic Black and Hispanic children consistently exhibited higher rates of poor adherence compared to non-Hispanic White children. Over time, poor adherence declined by 21.3% among children of non-Hispanic White caregivers (p = 0.046); however, the decline was not statistically significant among children of non-Hispanic Black (p = 0.505) or Hispanic caregivers (p = 0.405). Logistic regression analysis showed that CSHN with non-Hispanic Black (OR 1.40, 95% CI 1.16–1.68) and Hispanic (OR 1.42, 95% CI 1.18–1.72) caregivers were more likely to experience poor medication adherence compared to those with non-Hispanic White caregivers. No significant interactions were observed between survey periods and caregiver race/ethnicity.
Discussion: Using nearly two decades of nationally representative data, this study found that racial and ethnic disparities in medication adherence among CSHN have remained largely unchanged. Although poor medication adherence declined modestly overall, these improvements were driven primarily by children of non-Hispanic White caregivers, with no statistically significant gains among children of non-Hispanic Black or Hispanic caregivers. These findings suggest that the underlying drivers of poor adherence remain persistent.
Conclusion: Despite modest overall improvements in medication adherence among CSHN, racial and ethnic disparities persist. These findings underscore the need for targeted interventions addressing socioeconomic barriers, healthcare access, and culturally tailored education to improve adherence and reduce longstanding inequities in this vulnerable population.
Comments
Presented by Rajat Sharma.