A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
J Autism Dev Disord. 2024 May;54(5):1672-1679. doi: 10.1007/s10803-023-05911-0. Epub 2023 Feb 9.
This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.
本研究调查了美国一个大型、全支付方、具有全国代表性的住院患者样本中的住院情况,并确定了不同种族和族裔的自闭症成年人因各种疾病住院的比率差异。检查的疾病包括情绪障碍、癫痫、精神分裂症和可门诊治疗的急性病(ACSCs)。与白人非西班牙裔自闭症成年人相比,黑人、西班牙裔、亚裔或太平洋岛民(API)以及其他种族的自闭症成年人因主要诊断为情绪障碍而住院的比例较低。相比之下,黑人、西班牙裔、API 和其他种族的自闭症成年人因癫痫而住院的可能性高于白人自闭症成年人。与白人自闭症成年人相比,黑人自闭症成年人和西班牙裔自闭症成年人更有可能将精神分裂症作为主要诊断,但只有黑人自闭症成年人因 ACSC 而住院的可能性高于白人自闭症成年人。住院自闭症成年人的诊断患病率差异可能表明他们获得全面门诊护理的机会存在差异,这可能会导致这些住院治疗,同时也表明对诊断工具和治疗方法的有效性存在差异。保险政策和计划应优先优化门诊护理,以确保获得护理,并强调需要公平对待。