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Racial and ethnic differences in subspecialty service use by children with autism.

TitleRacial and ethnic differences in subspecialty service use by children with autism.
Publication TypeJournal Article
Year of Publication2013
AuthorsBroder-Fingert, S, Shui, AM, Pulcini, CD, Kurowski, D, Perrin, JM
Date Published2013 Jul
KeywordsAdolescent, African Americans, Autistic Disorder, Child, Child, Preschool, European Continental Ancestry Group, Female, Gastroenterology, Health Services, Hispanic Americans, Humans, Male, Medicine, Neurology, Nutritional Sciences, Odds Ratio, Psychiatry, Psychology, Clinical, Referral and Consultation, United States, Utilization Review, Young Adult

OBJECTIVE: To describe racial differences in use of specialty care among children with autism spectrum disorder.

METHODS: We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type.

RESULTS: We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]).

CONCLUSIONS: We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through.


Lead Author
Sarabeth Broder-Fingert

Study Aims and Objectives
To determine if the use of Autism Spectrum Disorder (ASD) subspecialty care and procedures differs based on the race or ethnicity of children and adolescents with ASD.

Methods- Sample, Procedure, Study Measures, Analysis
Participants were identified through the Partners HealthCare System Research Patient Database Repository, which is an online database of patient records and includes information about diagnoses, medications, and demographics. 1557 children between the ages of 2 and 21 were identified as having an ASD diagnosis and receiving subspecialty follow-up care, and thus were included in the study.

Results- Main Findings
Significant differences were found between the receipt of subspecialty appointments and procedures among the different racial and ethnic groups studied. Nonwhite children were less likely to receive Gastrointestinal care and procedures, and Hispanic children were less likely to receive neurological studies including EEG, MRIs, and Sleep.

Conclusion- Summary Statement
The differences found in the receipt of specialty care and procedures among the races and ethnicities studied, while significant, may be explained by several factors. Variance in Autism presentation and co-occurring health problems may require different follow up and specialty care. There also might be physician bias in understanding the referral needs of both white and nonwhite children, possibly under-referring or over-referring in different instances. Self-referral may also play a role, with nonwhite families having less access to care from sub-specialty providers. Finally, there may be a difference in follow up rates between white and nonwhite children with ASD. Referral rates might be equivalent, but nonwhite families may follow up less often and therefore not attend these subspecialty appointments.

Alternate JournalPediatrics
PubMed ID23776121