Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
School of Public Policy, University of Calgary, Calgary, AB, Canada.
Dev Med Child Neurol. 2020 Mar;62(3):338-345. doi: 10.1111/dmcn.14343. Epub 2019 Aug 30.
This study examined children's health care service use, mothers' workforce participation, and mothers' community engagement based on children's risk of developmental delay.
We used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children's health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3.
Among 1314 mother-child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49-10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14-1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at-risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay.
These results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year.
Early developmental delay risk was related to health care service use and costs. Diagnosis of neurodevelopmental disorder drove increased health care service use and costs. Early developmental delay risk did not relate to parental workforce participation. Early developmental delay risk did not relate to community engagement participation.
本研究根据儿童发育迟缓风险，考察了儿童保健服务的利用、母亲的劳动力参与和社区参与情况。
我们使用了“全民家庭研究”（All Our Families study）的前瞻性妊娠队列数据。在第 2 年使用年龄和阶段问卷（ASQ）评分来确定发育迟缓风险。为了调查儿童未被诊断出发育迟缓风险时的影响，敏感性分析排除了第 3 年神经发育障碍（NDD）诊断的报告。结果为从第 2 年到第 3 年，母亲报告的儿童健康和联合保健就诊情况（和估计费用）以及母亲的劳动力参与率和社区参与率。
在 1314 对母婴对子中，有 209 名（16%）儿童被 ASQ 评定为有发育迟缓风险，有 42 名（3%）儿童被诊断为患有 NDD。发育迟缓风险与联合保健服务的利用增加有关（发病风险比 5.04[第 3 年]；95%置信区间 2.49-10.2）和健康就诊（发病风险比 1.33[第 3 年]；95%置信区间 1.14-1.54）。有风险的儿童的平均预期联合保健费用高于无风险的儿童。然而，当从这项分析中排除有报告的 NDD 诊断的儿童时，在剩余的有风险人群中没有观察到服务使用和费用的增加。根据发育迟缓风险，家庭的社区参与度和工作场所参与度没有差异。
这些结果表明，有发育迟缓风险的儿童家庭的医疗保健服务使用增加是由于在随后的一年中被诊断为 NDD。
早期发育迟缓风险与医疗服务的利用和费用有关。神经发育障碍的诊断促使医疗保健服务的利用和费用增加。早期发育迟缓风险与父母的劳动力参与无关。早期发育迟缓风险与社区参与度无关。
