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Racial and ethnic differences in subspecialty service use by children with autism
Sarabeth Broder-Fingert1, Amy Shui, Christian D Pulcini
1Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, and Center for Child and Adolescent Health Research and Policy, Boston, MA, USA. sbroder-finger@partners.org
Insights
Racial and ethnic minority children with autism spectrum disorder received less specialty care, including gastroenterology and neurology services. These disparities highlight potential inequities in healthcare access and utilization for these children.
Area of Science:
- Pediatric healthcare disparities
- Autism spectrum disorder (ASD) research
- Health services research
Background:
- Children with autism spectrum disorder (ASD) often require specialized care for co-occurring conditions.
- Racial and ethnic disparities in healthcare access and utilization are well-documented across various pediatric conditions.
Purpose of the Study:
- To investigate and describe racial and ethnic differences in the utilization of specialty care services among children diagnosed with autism spectrum disorder (ASD).
Main Methods:
- A retrospective analysis of electronic health records for 3615 children aged 2-21 with an autism diagnosis (ICD-9 code 299.0) from 2000-2011.
- Rates of specialty provider visits and procedures were determined by race and ethnicity.
- Logistic regression models were employed to assess the association between race/ethnicity and subspecialty care utilization, controlling for demographic and payer variables.
Main Results:
- Significant racial and ethnic disparities were observed in the use of gastroenterology/nutrition, neurology, and psychiatry/psychology services.
- Non-white children, particularly African American and Hispanic children, were less likely to utilize gastroenterology (GI) services and undergo GI procedures like colonoscopy and endoscopy.
- Lower rates of neurological and psychiatric testing were also noted among Hispanic and African American children.
Conclusions:
- Racial and ethnic disparities exist in the utilization of specialty care and diagnostic procedures for children with autism spectrum disorder (ASD).
- Potential contributing factors may include differences in clinical presentation, referral patterns, or adherence to referrals among minority populations.
- Further research is needed to understand and address these disparities to ensure equitable care for all children with ASD.
Objective:
To describe racial differences in use of specialty care among children with autism spectrum disorder.
Methods:
We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type.
Results:
We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]).
Conclusions:
We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through.
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