Health Services Utilization Among Children With and Without Autism Spectrum Disorders
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Using data from multiple health systems (2009–2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)—including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic characteristics, comorbid physical health, and mental health conditions. Results indicated that youth with an ASD had greater health care use in many categories, but were less likely to receive important preventive services including flu shots and other vaccinations. An improved understanding of the overall patterns of health care use among this population could enable health systems to facilitate the receipt of appropriate and effective health care.
KeywordsAutism spectrum disorders Health care utilization Preventive services Children Adolescents
We are grateful for the analytic support provided by Matthew Lakoma (HPHCI), Jialuo Liu (KPSC), and Heather Freiman (KPGA) and for the project management support provided by Donna Rusinak (HPHCI), Magdalena E. Pomichowski (KPSC), Marta Lutsky (KPNC), and Heather Freiman (KPGA). This work was supported by the National Institute of Mental Health (Grants U19MH092201, K01MH095823). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Janet R. Cummings led the conceptualization and design of the study, drafted the initial manuscript, revised the manuscript, and approved the final manuscript as submitted. Frances L. Lynch and Lisa A. Croen contributed to the conceptualization and design of the study, supervised data management efforts at a participating site, reviewed and revised the manuscript, and approved the final manuscript as submitted. Kristal C. Rust and Phillip Crawford carried out the statistical analyses and assisted with interpretation of the results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Yinge Qian contributed to the statistical analyses and assisted with interpretation of the results, critically reviewed the manuscript, and approved the final manuscript as submitted. Karen J. Coleman, Jeanne Madden, Ashli A. Owen-Smith, Vincent M. Yau, Kathryn A. Pearson, Maria L. Massolo, and Virginia P. Quinn contributed to the conceptualization of the study design, coordinated and supervised data management efforts at a participating site, critically reviewed the manuscript, and approved the final manuscript as submitted.
- American Academy of Pediatrics. (2014). Well-child care: A check-up for success. http://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx. Accessed March 2015.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. In American Psychiatric Association (5th ed.). dsm.psychiatryonline.org. Accessed February 1, 2015.
- Bowen, S. E. (2014). Autism spectrum disorders (ASD): State of the states of services and supports for people with ASD. Washington, DC: L & M Policy Research LLC.Google Scholar
- Centers for Disease Control and Prevention. (2014). People at high risk of developing flu-related complications. http://www.cdc.gov/flu/about/disease/high_risk.htm. Accessed March 2015.
- Copeland, L., & Buch, G. (2013). Early intervention issues in autism spectrum disorders. Autism: The international Journal of Research and Practice, 3, 109.Google Scholar
- Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118, e1203–e1211. doi: 10.1542/peds.2006-0127.CrossRefPubMedGoogle Scholar
- Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism: National Survey of Children’s Health. Archives of Pediatrics and Adolescent Medicine, 160, 825–830. doi: 10.1001/archpedi.160.8.825.CrossRefPubMedGoogle Scholar
- Joshi, G., et al. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361–1370. doi: 10.1007/s10803-010-0996-9.CrossRefPubMedGoogle Scholar
- Levy, S. E., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics: JDBP, 31, 267–275. doi: 10.1097/DBP.0b013e3181d5d03b.CrossRefPubMedGoogle Scholar
- Long, J. S. (1997). Count outcomes: Regression models for counts. In Regression models for categorical and limited dependent variables. Advanced quantitative techniques in the social sciences (pp. 217–250). Thousand Oaks, CA: Sage Publications.Google Scholar
- Medicode (Firm). (1996). ICD-9-CM: International classification of diseases, 9th revision, clinical modification. Salt Lake City, UT: Medicode.Google Scholar
- Mental Health Research Network. (2015). Mental Health Research Network participating members: 13 sites across the U.S. https://sites.google.com/a/mhresearchnetwork.org/mhrn/home/Members. Accessed April 21, 2015.
- Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929. doi: 10.1097/CHI.0b013e318179964f.CrossRefPubMedGoogle Scholar
- StataCorp LP. (2013). Stata Statistical Software (13.1 ed). College Station, TX.Google Scholar
- U.S. Census Bureau. (2000, 2006–2010). United States Census, American Community Survey. http://www.census.gov/acs/www/.
- Van Cleave, J., Heisler, M., Devries, J. M., Joiner, T. A., & Davis, M. M. (2007). Discussion of illness during well-child care visits with parents of children with and without special health care needs. Archives of Pediatrics and Adolescent Medicine, 161, 1170–1175. doi: 10.1001/archpedi.161.12.1170.CrossRefPubMedGoogle Scholar