Zhang Wanqing, Johnson Khalilah R
Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Division of Occupational Science and Occupational Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Children (Basel). 2023 Jul 15;10(7):1228. doi: 10.3390/children10071228.
There is a limited amount of research on geographic differences in preventable hospitalizations for ambulatory care sensitive conditions (ACSCs) among children with autism. The purpose of this study was to examine US regional differences in potentially preventable hospital admissions for pediatric inpatients diagnosed with autism. Hospital discharge data for six pediatric preventable conditions were obtained from the 2016-2019 National Inpatient Sample (NIS) under the US Agency for Healthcare Research and Quality. Geographic differences in preventable hospitalizations for children with autism were examined by US census regions and divisions. Multiple logistic regression analyses were conducted to examine child and clinical characteristics associated with ACSCs hospitalization across four US regions; the dependent variable was the likelihood of ACSCs hospitalization. Additionally, this study further explored the variation in preventable hospitalization among racial and ethnic groups for each region or division. Of the 138,305 autistic inpatients aged 2-17 years, about 10% had a primary diagnosis related to ACSCs. The results showed that the highest proportion of preventable hospitalizations for autistic children occurred in the middle Atlantic division of the northeast region. Racial differences were observed across all US regions, particularly in the northeast and south regions. Black children with autism were more likely to be hospitalized for ACSCs compared to White children with autism in three of the four US regions. Our results highlight the significant racial disparities in potentially avoidable hospitalizations among US children with autism. Examining geographic and racial differences in potentially avoidable hospitalizations could inform policy and practice while gaining a better understanding of pediatric patients with autism and where their families access health services. The findings of this study may help policymakers to identify where intervention is needed to tackle health inequities in the accessibility to quality primary care in the US. Further studies with more detailed investigation are recommended to better understand the mechanisms underlying these disparities, and to formulate effective regional policy and clinical practices while considering the unique needs and challenges of underserved children with autism.
关于自闭症儿童中可预防的门诊护理敏感疾病（ACSC）住院情况的地域差异研究有限。本研究的目的是调查美国被诊断为自闭症的儿科住院患者潜在可预防的住院情况的地区差异。六种儿科可预防疾病的医院出院数据来自美国医疗保健研究与质量局下属的2016 - 2019年全国住院患者样本（NIS）。通过美国人口普查区域和分区研究自闭症儿童可预防住院情况的地域差异。进行了多项逻辑回归分析，以研究与美国四个地区ACSC住院相关的儿童和临床特征；因变量是ACSC住院的可能性。此外，本研究进一步探讨了每个地区或分区中不同种族和族裔群体之间可预防住院情况的差异。在138,305名2至17岁的自闭症住院患者中，约10%的患者主要诊断与ACSC相关。结果显示，自闭症儿童可预防住院比例最高的地区是东北地区的大西洋中部分区。在美国所有地区都观察到了种族差异，特别是在东北部和南部地区。在四个美国地区中的三个地区，患有自闭症的黑人儿童比患有自闭症的白人儿童更有可能因ACSC住院。我们的结果凸显了美国自闭症儿童在潜在可避免住院方面存在的显著种族差异。研究潜在可避免住院情况的地域和种族差异可为政策和实践提供参考，同时更好地了解自闭症儿科患者及其家庭获取医疗服务的地点。本研究结果可能有助于政策制定者确定在美国优质初级保健可及性方面解决健康不平等问题所需进行干预的地点。建议进行更详细调查的进一步研究，以更好地理解这些差异背后的机制，并在考虑自闭症服务不足儿童的独特需求和挑战的同时制定有效的区域政策和临床实践。
