Leveraging Trajectories of Health and Services Use to Improve the Health of Autistic Young Persons

项目摘要 随着儿童期自闭症谱系障碍（ASD）患病率的增加，自闭症年轻人（10-24岁） 年）是一个不断增长，但研究不足的群体。研究差距促进自闭症年轻人的脆弱性 长期健康状况不佳，因为对他们的医疗保健需求了解有限， 服务同时发生的条件和服务利用率的横截面率升高有充分的记录 在自闭症青年中，但在各年龄段的健康和服务模式方面仍然存在知识差距， 需要有相关的目标和时间来指导干预措施。此外，先前的工作表明，社会经济 弱势群体或种族/族裔多样化群体特别容易受到复合健康影响， 最佳服务模式。我们假设有不同的健康状况和健康模式， 在自闭症年轻人中的跨年龄服务，共同影响未来的健康，影响是 可能因社会经济劣势或种族/民族差异而扩大。2008-2023年使用国家 年龄在10-24岁之间的不同美国人群的医疗补助数据（150万人连续5年入组; 600，000 ASD，975，000非ASD），我们将在5年的健康期内模拟纵向轨迹 条件和服务，并量化健康和健康服务历史对健康的综合影响， 未来10年我们将应用基于组的多轨迹方法（目标1）确定特定年龄的健康 条件轨迹类（3个领域：大脑;身体;行为健康）和（目标2）健康服务 轨迹分类（3个领域：住院/急诊;门诊;药物）。我们还将量化 健康和服务类别组合（目标3）对研究参与者未来10年健康的影响，使用（a） 疾病负担指标（残疾调整寿命年、残疾寿命年、因残疾而损失的寿命年） 过早死亡，健康损失比例），（B）住院/急诊服务利用的风险，和（c）死亡率 （全因死亡;自杀;因意外伤害死亡）。在所有目标中，我们评估ASD与非ASD 总体而言，以及按性别、种族/民族和社会经济地位群体划分的异质性。作为阶段的一部分， 公共卫生的方法，我们采用强大的，双向社区参与的方法在所有研究年的关键 我们的社区倡导者，包括自闭症患者，对我们研究的各个阶段的投入。我们 团队拥有丰富的经验和研究人口知识，可以进行这些新颖的最先进的轨迹 方法和健康指标，在这个独特的和多样化的人口的基础上，15年的全国医疗补助 数据该项目将提供多领域“真实的世界”卫生和服务经验的关键证据 以及它们对长期健康的影响，需要优化自闭症年轻人的健康干预和结果 进入成年期的人。

PROJECT ABSTRACT With increasing prevalence of autism spectrum disorder (ASD) in childhood, autistic young persons (10-24 years) are a growing, yet understudied group. The research gap promotes autistic young person’s vulnerability to long-term poor health due to limited understanding of their health care needs and rising pressure on services. Elevated cross-sectional rates of co-occurring conditions and service utilization are well-documented in autistic young persons, but knowledge gaps remain regarding health and services patterns across age, and relevant targets and their timing needed to guide interventions. Further, prior work suggests socioeconomically disadvantaged or race/ethnically diverse groups are particularly at risk for compounded health effects and sub- optimal service patterns. We hypothesize that there are distinct patterns of health conditions and health services across age in autistic young persons which, together, impact future health, and the impact is potentially magnified by socioeconomic disadvantage or race/ethnic disparities. Using national 2008-2023 Medicaid data for a diverse US population aged 10-24 years (1.5 million with 5-years continuous enrollment; 600,000 ASD, 975,000 non-ASD), we will model longitudinal trajectories over a 5-year period of health conditions and services and quantify the combined effect of health and health services history on health over the next 10 years. We will apply group-based multi-trajectory methods to (Aim 1) determine age-specific health conditions trajectory classes (3 domains: brain; physical; behavioral health), and (Aim 2) health services trajectory classes (3 domains: inpatient/emergency; outpatient; medications). We will also quantify impact of health and services class combinations (Aim 3) on study participants’ health in the next 10 years using (a) burden of disease metrics (disability adjusted life years, years of life lived with disability, years of life lost due to premature death, health loss proportion), (b) risk of inpatient/emergency services utilization, and (c) mortality (all-cause mortality; suicide; death due to unintentional injury). Across all Aims, we assess ASD vs. non-ASD overall, as well as heterogeneity by sex, race/ethnicity, and socioeconomic status groups. As part of PHASES’ public health approach, we employ robust, 2-way community engagement methods in all study years for critical input from our community advocates, including autistic individuals, regarding all phases of our research. Our team has the experience and study population knowledge to conduct these novel state-of-the-art trajectory methods and health metrics, in this unique and diverse population based on 15-years of nation-wide Medicaid data. This project will provide critical evidence on multi-domain ‘real world’ health and services experiences and their effects on long term health, needed to optimize health interventions and outcomes for autistic young persons aging into adulthood.