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Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching
E Nicholson1,2, E Doherty3, S Guerin4
1UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, UCD College of Health and Agricultural Sciences, Dublin, Ireland.
Insights
Children with intellectual disabilities (ID) experienced more unmet healthcare needs and increased hospital visits by age 9 compared to peers. This study used propensity score matching to analyze healthcare utilization in children with ID.
Area of Science:
- Child Health
- Health Services Research
- Intellectual Disability Research
Background:
- Measuring health disparities in children with intellectual disabilities (ID) is complex due to confounding factors influencing health and healthcare access.
- Previous research often struggles to isolate the specific impact of ID on healthcare utilization and unmet needs.
Purpose of the Study:
- To compare healthcare utilization and unmet needs in children with intellectual disability (ID) against a matched control group.
- To analyze longitudinal data from Irish children aged 9 and 13 between 2006 and 2014.
Main Methods:
- Utilized the 'Growing up in Ireland' longitudinal cohort study data.
- Employed propensity score matching (PSM) to create comparable groups of children with and without ID.
- Applied logistic regression to analyze healthcare utilization and unmet needs at ages 9 and 13.
Main Results:
- Children with ID showed similar rates of general practitioner and emergency department visits compared to controls.
- Children with ID had a higher likelihood of hospital doctor visits and overnight hospital stays by age 9.
- Primary caregivers of children with ID reported greater unmet health needs at both ages 9 and 13.
Conclusions:
- Propensity score matching offers a robust method to compare healthcare use in children with ID, mitigating confounding variables.
- The findings highlight specific areas of increased healthcare utilization and unmet needs for children with ID, suggesting potential inequities.
- This research provides a novel approach to understanding and addressing health disparities in children with intellectual disabilities.
Background:
Health disparities for children with intellectual disabilities can be challenging to measure due to many other factors that can impact health and healthcare use. The aim of the current study was to use longitudinal cohort data to compare children with intellectual disability (ID) in Ireland between 2006 and 2014 on healthcare utilisation and unmet need, at ages 9 and 13, using a propensity score matching (PSM) approach.
Methods:
Using data from the Growing up in Ireland study, PSM was used to identify an appropriate control sample to compare with a sample of children with ID (n = 124). Participants were matched on variables that are known to influence healthcare utilisation to reduce the impact of confounding variables between groups so that differences between the groups can be estimated. Logistic regression was used to estimate effects at ages 9 and 13.
Results:
Children with ID were no more likely to have visited a general practitioner or emergency department in the past 12 months than children without ID. They did have a greater likelihood of visiting a doctor in a hospital in the past 12 months and of having an overnight stay in hospital by age 9. Primary caregivers of children with ID were more likely to report unmet health needs at ages 9 and 13.
Conclusions:
This approach is a novel means of comparing healthcare use in this population by balancing the impact of other factors that may result in inequities, to which children with ID may be more vulnerable.
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