National Center for Health Statistics (B Zablotsky and SJ Blumberg), Hyattsville, Md.
National Center on Birth Defects and Developmental Disabilities (MJ Maenner), Atlanta, Ga.
Acad Pediatr. 2019 Sep-Oct;19(7):740-747. doi: 10.1016/j.acap.2019.02.013. Epub 2019 Mar 8.
Geographic differences may provide insight into what factors influence the likelihood that a child is diagnosed with autism spectrum disorder (ASD) in the United States; yet, there have been few nationally representative surveys that have explored this topic. The current study expands the limited literature by analyzing regional differences in ASD prevalence, service utilization, and the presence of unmet needs within a nationally representative sample of children.
Data were drawn from the 2014-2016 National Health Interview Survey (NHIS), a nationally representative household survey of the noninstitutionalized US population. Children 3 to 17 years of age were included in the analytic sample. Prevalence estimates accounted for the complex survey design of the NHIS, and differences between geographic regions were compared using logistic/linear regressions with and without adjustment for child/family characteristics.
The prevalence of ASD was highest in the Northeast (3.0%), followed by the Midwest (2.4%), South (2.4%), and West (2.3%). A significant difference was found between the Northeast and West (P < .05); however, after accounting for child and family characteristics, this difference was no longer significant. Children with ASD in the Northeast were the most likely to have seen a specialist in the past year. Approximately 1 in 8 children with ASD experienced at least 1 unmet need, but there were no differences found by geographic region.
Although differences in prevalence were not significant after adjustment, service utilization differences remained. It appears that children with ASD in the Northeast utilize the greatest number of specialty services when compared to children with ASD from other parts of the country.
地理差异可能有助于了解哪些因素会影响美国儿童自闭症谱系障碍（ASD）的诊断几率；然而，很少有全国性代表性调查对此进行了探讨。本研究通过分析全国代表性儿童样本中 ASD 患病率、服务利用率以及未满足需求的存在情况，扩展了有限的文献。
数据来自于 2014-2016 年全国健康访谈调查（NHIS），这是对美国非机构化人群的全国性代表性家庭调查。分析样本包括 3 至 17 岁的儿童。患病率估计考虑了 NHIS 的复杂调查设计，使用带有和不带有儿童/家庭特征调整的逻辑/线性回归比较了地理区域之间的差异。
ASD 的患病率在东北部最高（3.0%），其次是中西部（2.4%）、南部（2.4%）和西部（2.3%）。东北部和西部之间存在显著差异（P <.05）；然而，在考虑了儿童和家庭特征后，这种差异不再显著。过去一年中，东北地区 ASD 儿童最有可能看过专家。大约每 8 名 ASD 儿童中就有 1 名至少有 1 项未满足的需求，但在地理区域之间没有发现差异。
尽管在调整后，患病率的差异并不显著，但服务利用率的差异仍然存在。与来自该国其他地区的 ASD 儿童相比，东北地区的 ASD 儿童似乎利用了最多数量的专科服务。
