Medicaid Enrollment and Service Use Among Adults With Down Syndrome.
Medicaid Enrollment and Service Use Among Adults With Down Syndrome.
复制标题
DOI：
10.1001/jamahealthforum.2023.2320
复制
发表时间：
2023-08-04
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
在美国医疗补助系统中，唐氏综合症成人的登记模式和特征是什么？与其他群体相比如何？在这项2011年至2019年的队列研究中，123024名唐氏综合征成年人，1182246名智力残疾成年人，以及随机选择的3176371名无发育障碍的对照组，与随机选择的对照组相比，唐氏综合征成年人更一致地参加了医疗补助，并且具有更高的成本和服务使用。这项研究表明，医疗补助计划是至关重要的，以确保成年唐氏综合征和促进获得卫生服务的社区与高医疗保健需求和成本。唐氏综合症是智力残疾的主要遗传原因，并自动使个人有资格获得社会保障保险。因此，医疗补助是痴呆症、肥胖和过早死亡高风险人群的主要健康保险提供者。尽管医疗补助对唐氏综合症成年人很重要，但人们对这一人群如何使用医疗补助知之甚少。描述唐氏综合征成年人与智力残疾成年人和医疗补助随机样本成年人的入学率、医疗保健使用和医疗补助费用。在这项队列研究中，数据来自2011年1月1日至2019年12月31日期间任何时间点参加医疗补助的18岁或以上成年人的索赔队列。参与者是有1个或多个住院索赔或2个或多个其他索赔的国际疾病分类，第九次修订代码或国际疾病和相关健康问题统计分类，第十次修订代码唐氏综合征或智力残疾的登记者，以及无发育残疾的随机样本。分析于二零二二年六月至二零二三年二月进行。数据通过2个数据报告系统链接。主要结果是登记的人口统计学特征，登记的特点，成本和服务的使用。这项队列研究包括123024名唐氏综合征患者（820 273人-年的覆盖率;平均[SD]年龄，35 [14.7]岁;中位年龄，33岁[IQR，21-48岁]; 51.6%的男性; 14.1%的黑人个体; 16.7%的西班牙裔个体;白色人占74.6%），智力残疾人1 182 246人（平均[SD]年龄，37.1 [16.8]岁;中位年龄，33岁[IQR，22-50岁]; 56.5%男性; 22.0%黑人个体; 11.7%西班牙裔个体;和69.5%的白色个体），以及3 176 371名无发育障碍的个体（平均[SD]年龄，38 [18.6]岁;中位年龄，33岁[IQR，21-52岁]; 43.8%的男性; 23.7%的黑人个体; 20.7%的西班牙裔个体;和61.3%的白色个体）。唐氏综合征患者参加医疗补助的中位年龄为8.0岁（IQR，5.0-9.0岁;平均值[SD]，6.6 [2.6]岁）。唐氏综合征组（中位数，26 278美元/人年[IQR，11 145- 55 928美元/人年]）的费用高于无发育障碍组（中位数，6173美元/人年[IQR，868 - 58 390美元/人年]）。与患有唐氏综合征的白色成年人相比，患有唐氏综合征的亚洲人、黑人、西班牙裔、美洲原住民和太平洋岛民成年人的每人年费用和索赔较少。这项对参加医疗补助计划的唐氏综合征患者的队列研究发现，在具有高医疗保健需求的人群中，有一致的入学率和高的医疗保健使用率。比较唐氏综合征患者和智力残疾患者的结果相似，两组均不同于无发育障碍的医疗补助登记者样本。医疗补助数据是了解唐氏综合症患者健康和福祉的有用工具。这项队列研究描述了唐氏综合征成年人与智力残疾成年人和参加医疗补助的成年人随机样本的入学率、医疗保健使用率和医疗补助费用。
What are the enrollment patterns and characteristics of adults with Down syndrome in the US Medicaid system, and how does that compare with other groups? In this cohort study from 2011 to 2019 of 123 024 adults with Down syndrome, 1 182 246 adults with intellectual disability, and a randomly selected comparison group of 3 176 371 individuals without developmental disabilities, adults with Down syndrome were more consistently enrolled in Medicaid and had higher costs and service use compared with the randomly selected comparison group. This study suggests that the Medicaid program is vital for insuring adults with Down syndrome and facilitating access to health services for a community with high health care needs and costs. Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid. To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid. In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023. Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use. This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome. This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome. This cohort study describes enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid.