比较有智力障碍、自闭症谱系障碍和同时患有这两种障碍的儿童未满足的医疗保健需求。
Comparison of unmet health care needs in children with intellectual disability, autism spectrum disorder and both disorders combined.
机构信息
Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
出版信息
J Intellect Disabil Res. 2022 Jul;66(7):617-627. doi: 10.1111/jir.12932. Epub 2022 Mar 31.
BACKGROUND
The purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a contributing factor. Children with ID may be masked in the health care system due to increased diagnosis and awareness of ASD. The needs, unmet needs and insurance coverage of children with ID alone, ASD alone, and co-occurring ID and ASD were assessed in this study.
METHODS
The 2016 to 2019 United States' Census Bureau National Survey of Children's Health was used to determine differences in unmet needs, care not received and health insurance coverage during the past year for children with ID and/or ASD. Adjusted odds ratios and 95% confidence intervals for care not received were determined controlling for sex, insurance, race, age and parents' highest education level.
RESULTS
Children with ID were nearly four times more likely not to receive needed medical care as children with ASD. Results were similar for unmet hearing and mental health care. Children with both ID and ASD were more likely to have unmet health care but less likely to have unmet medical care compared with children with ASD alone. There were no significant differences for unmet dental or vision care. Children with ID were 3.58 (95% confidence interval: 1.6-8.0) times more likely to have inconsistent health insurance compared with children with ASD.
CONCLUSIONS
Children with ID alone are more likely to have unmet medical, hearing and mental health care needs than children with ASD alone. Children with co-occurring ID and ASD have a large amount of general unmet health care needs but less unmet medical needs. Children with ID are less likely to have consistent health insurance than children with ASD. This hinders the ability of children with ID to receive quality care. Further research is needed to determine if the diagnosis of ASD in children in the United States is negatively affecting children with ID alone.
背景
本研究旨在评估与自闭症谱系障碍（ASD）相比，智力障碍（ID）儿童的未满足医疗保健需求，以及获得健康保险覆盖范围是否是一个促成因素。由于 ASD 的诊断和认知度提高，ID 儿童可能在医疗保健系统中被掩盖。本研究评估了 ID 儿童、ASD 儿童、同时患有 ID 和 ASD 的儿童的需求、未满足的需求和保险覆盖情况。
方法
本研究使用了 2016 年至 2019 年美国人口普查局国家儿童健康调查的数据，以确定 ID 和/或 ASD 儿童在过去一年中未满足的需求、未接受的护理和健康保险覆盖范围的差异。通过控制性别、保险、种族、年龄和父母最高教育水平，确定了未接受护理的调整后优势比和 95%置信区间。
结果
与 ASD 儿童相比，ID 儿童未接受所需医疗护理的可能性几乎高出四倍。听力和心理健康护理的未满足情况也类似。同时患有 ID 和 ASD 的儿童更有可能存在未满足的医疗保健需求，但与仅患有 ASD 的儿童相比，未满足的医疗保健需求较少。在未满足的牙科或视力保健方面没有显著差异。与 ASD 儿童相比，ID 儿童的健康保险不一致的可能性高 3.58 倍（95%置信区间：1.6-8.0）。
结论
与仅患有 ASD 的儿童相比，单独患有 ID 的儿童更有可能存在未满足的医疗、听力和心理健康保健需求。同时患有 ID 和 ASD 的儿童有大量的一般未满足的医疗保健需求，但未满足的医疗需求较少。与 ASD 儿童相比，ID 儿童获得一致健康保险的可能性较低。这阻碍了 ID 儿童获得优质护理的能力。需要进一步研究以确定美国儿童 ASD 的诊断是否对单独患有 ID 的儿童产生负面影响。
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