Racial and Ethnic Differences in Subspecialty Service Use by Children With Autism
Racial and Ethnic Differences in Subspecialty Service Use by Children With Autism
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DOI：
10.1542/peds.2012-3886
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发表时间：
2013-07-01
期刊：
影响因子：
8
通讯作者：
Perrin, James M.
中科院分区：
文献类型：
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作者：
Broder-Fingert, Sarabeth;Shui, Amy;Perrin, James M.
目的：描述自闭症谱系障碍儿童在使用专科护理方面的种族差异。方法：我们通过使用研究患者数据存储库，确定了2000年至2011年在一家主要学术健康中心使用国际疾病分类第九版自闭症代码（299.0）的2至21岁患者，并确定了按种族划分的专科提供者就诊率和程序。然后，我们使用逻辑回归，以确定关联率的专科访问和程序与种族和民族，控制性别，年龄和付款人type.RESULTS：我们确定了3615例（2935白色，243西班牙裔，188非洲裔美国人，和249其他）。最显著的差异是在使用胃肠病学/营养服务方面。非白人儿童不太可能使用GI/营养专业提供者（非裔美国人，比值比= 0.32 [第95百分位数置信区间：0.18-0.55];西班牙裔，0.32 [0.20-0.51];其他，0.56 [0.34-0.92]）以及神经病学（非裔美国人，0.52 [0.33-0.83];西班牙裔，0.40 [0.27-0.59]）和精神病学/心理学（非裔美国人，0.44 [0.27-0.72];西班牙裔，0.60 [0.41-0.88];其他，0.62 [0.38-0.99]）。非白人儿童不太可能进行GI检查：结肠镜检查（非裔美国人，0.23 [0.10-0.53];西班牙裔，0.26 [0.14-0.50]），内镜检查（非裔美国人，0.31 [0.16-0.58];西班牙裔，0.27 [0.16-0.46];其他，0.53 [0.31-0.90]）和粪便研究（非裔美国人，0.49 [0.30-0.91]）。西班牙裔儿童的神经系统和其他测试率较低：脑电图（西班牙裔，0.53 [0.35-0.78]），脑部MRI（非裔美国人，0.37 [0.22-0.63];西班牙裔，0.62 [0.42-0.90]），睡眠研究（西班牙裔，0.18 [0.04-0.76]）和神经精神测试（西班牙裔，0.55 [0.32-0.96]）.结论：我们发现在被诊断为自闭症的儿童中，在使用护理和程序方面存在种族和民族差异。对这些发现的可能解释包括介绍、转诊率或转诊跟进方面的差异。
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.