Disability-Based Discrimination and Forgone Health Care in Children With Special Health Care Needs

Area of Science:

• Health Services Research
• Pediatric Health
• Health Equity

Background:

• Disability-based discrimination in healthcare can impede access and alter healthcare utilization patterns.
• Children with special health care needs (CSHCN) are particularly vulnerable to such discrimination.
• Understanding the prevalence and impact of discrimination is vital for improving care for CSHCN.

Purpose of the Study:

• To characterize disability-based discrimination among a national cohort of CSHCN.
• To evaluate the association between disability-based discrimination and healthcare use, including forgone care.
• To identify potential disparities in healthcare access related to disability discrimination.

Main Methods:

• Cross-sectional study utilizing data from the 2021 and 2022 National Survey of Children's Health (NSCH).
• Descriptive statistics compared demographics by discrimination exposure.
• Multivariable logistic regression analyzed the association between discrimination and healthcare use (forgone care, ED visits, hospitalizations).

Main Results:

• 11.0% of US CSHCN (representing 14 million children) experienced disability-based discrimination.
• CSHCN experiencing discrimination were more likely to have public insurance and a disability impacting daily activities.
• Discrimination was associated with a 2.13-fold increased odds of forgone care and a 1.45-fold increased odds of an ED visit.

Conclusions:

• Approximately 1 in 10 CSHCN face discrimination due to their disability.
• This discrimination significantly increases the likelihood of necessary healthcare being forgone.
• Interventions targeting disability-based discrimination are essential for enhancing healthcare access and equity for CSHCN.