McKeehan Ashlyn J, Smith Cristina R, Pelatti Christina Y, Bendixen Roxanna, Knox Sara
Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA.
Division of Occupational Therapy, Medical University of South Carolina, Charleston, South Carolina, USA.
J Intellect Disabil Res. 2025 Aug;69(8):655-663. doi: 10.1111/jir.13246. Epub 2025 Apr 30.
The objective of this retrospective observational study was to examine disparities in health care utilisation for children with Down syndrome (DS).
Outpatient Medicaid claims from 2016 to 2018 were used to examine the utilisation of therapy services and annual Medicaid payments for children with DS based on sex, race and age. Multilevel logistic regression was used to analyse the relationship of therapy utilisation with sex, race and age. Gamma-distributed log link model was used to analyse the relationship between annual Medicaid payments and race.
The cohort consisted of 17 813 children with DS aged 21 and under. There was no significant difference in utilisation of therapy services between sexes. The likelihood of receiving therapy services decreased for Black or other race individuals compared to White. White individuals had higher annual Medicaid payments than Black or other race individuals. The likelihood of receiving therapy services increased for children 3-17 years old when compared to children aged 0-2 years old.
There are significant disparities in therapy utilisation for children with DS related to race and age. Increased annual Medicaid payments for White individuals may indicate that they are receiving more outpatient services than the Black/other populations. Decreased therapy utilisation for ages 18-21 years corresponds with the transition to adulthood. The decreased likelihood of receiving therapy services for ages 0-2 is concerning due to the importance of early intervention. Further research is needed to evaluate factors contributing to disparities in outpatient utilisation for children with DS.
这项回顾性观察研究的目的是调查唐氏综合征（DS）患儿在医疗保健利用方面的差异。
利用2016年至2018年的门诊医疗补助索赔数据，根据性别、种族和年龄，研究DS患儿的治疗服务利用情况和年度医疗补助支付情况。采用多水平逻辑回归分析治疗利用与性别、种族和年龄之间的关系。采用伽马分布对数链接模型分析年度医疗补助支付与种族之间的关系。
该队列包括17813名21岁及以下的DS患儿。两性在治疗服务利用方面没有显著差异。与白人相比，黑人或其他种族个体接受治疗服务的可能性降低。白人的年度医疗补助支付高于黑人或其他种族个体。与0至2岁的儿童相比，3至17岁儿童接受治疗服务的可能性增加。
DS患儿在治疗利用方面存在与种族和年龄相关的显著差异。白人年度医疗补助支付的增加可能表明他们比黑人/其他人群接受了更多的门诊服务。18至21岁治疗利用的减少与向成年期的过渡相对应。由于早期干预的重要性，0至2岁接受治疗服务的可能性降低令人担忧。需要进一步研究以评估导致DS患儿门诊利用差异的因素。
