The prevalence of autism spectrum disorder (ASD) has increased dramatically in recent years and affects every race, ethnicity, and socioeconomic status; thus, it requires an adequate and integrated system that supports quality primary care and health equity. Hospitalization for ambulatory care sensitive conditions (ACSCs) has been examined extensively as an indicator of the accessibility and overall effectiveness of primary health care. Families of children with ASD may experience more stress related to unmet primary care needs that may lead to potentially avoidable hospitalizations for ACSCs. Among children with ASD, Hispanics and non-Hispanic Blacks are less likely than non-Hispanic Whites to have a usual source of care and to have had recommended preventive treatments. Little is known about associations between race/ethnicity and preventable hospitalization for ACSCs among children with ASD.
This study compared ACSCs hospitalization patterns and outcomes among autistic children nationally by race/ethnicity and income level. Using secondary data from the US Nationwide Inpatient Sample (NIS), we conducted multivariable regression analyses to determine the potential effect of race and income level on the likelihood of inpatient stays for ACSCs among autistic children after controlling demographic and clinical characteristics.
Our results highlight the existing racial/ethnic and income disparities in preventable hospitalization among underserved children. Racial minority and children from low-income family have poorer primary care experiences and have higher risk of preventable hospitalizations for ACSCs. Inequities of access to health care among racial/ethnic minorities were most notable for autistic children with chronic preventable conditions. Specifically, the burden of asthma hospitalization falls disproportionally on autistic children of Black race. ASD disparities and inequities of access to health care among racial/ethnic groups persist. Some hospitalizations may be avoided through better primary care and chronic disease management such as improving parent and provider communication for adherence to asthma medications.
Clinical and social programs, policies and interventions need to be aimed at ensuring the availability of and accessibility to quality primary care for low-income Hispanic and Black children with ASD and mitigating health inequities associated with potentially avoidable hospitalization.
Contact for more information:
Wanqing Zhang
Research Methodologist
Assistant Professor
3003 Bondurant Hall
CB #7122
Email: wanqing_zhang@med.unc.edu
Office phone: (919) 962-4069
Principal Investigators:
Wanqing Zhang, PI
Linda Watson, Co-I
Khalilah Johnson, Co-I
Lead Principal Investigators:
Wanqing Zhang
Primary Funding Source:
Health Resources and Services Administration (HRSA)
Project Start Date:
September 1, 2021
Project End Date:
August 31, 2023