Healthcare Utilization and Delay of Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey (NHIS), 2006-2007

Background:

Studies document significant health impacts of many developmental disabilities (DDs). Further study of access to care is needed by disability type and race-ethnicity.  We examined population-based data using 2006-2007 NHIS on healthcare utilization and delay among 15,639 children ages 3-17 with and without disabilities.

Objectives:

This study provides nationally representative estimates of health utilization and delay among US children with DDs.

Methods:

Children in three groups, autism or mental retardation (MR; N=207); attention-deficit hyperactivity disorder (ADHD) without autism or MR (N=1013); and learning disability (LD) or other developmental delay without ADHD, autism, or MR (N=720), were compared to children without DDs on healthcare indicators (e.g. seeing a medical specialist). Further analyses were conducted on 3 subgroups of children with autism/MR:  autism only (N=91), MR only (N=87), and both conditions (N=24). Non-Hispanic White (NHW) and non-Hispanic Black (NHB) children were compared within each of the three main disability groups (but not the three autism/MR subgroups because of small sample sizes). Adjusted odds ratios (AOR) were calculated from logistic regression in SUDAAN to account for the complex sample design.

Results: Children in each DD group were significantly (p<0.05) more likely to have recently seen a medical specialist (21.0-69.1% depending on disability), mental health professional (12.5-59.7%), ancillary therapist (e.g. physical, speech, respiratory, occupational; 11.1-58.5%), and to have >9 annual healthcare visits (13.4-36.4%) than children without DDs. Associations remained significant after adjusting for sex and age. Strongest associations for each outcome were found for the autism/MR group.  For example, they were substantially more likely to have seen an ancillary therapist (AOR= 37.3, 95% CI=26.2-53.0) and have >9 office visits in the past year (AOR=15.4, 95% CI=10.2-23.3). Associations for all outcomes remained extremely strong in the autism/MR subgroups.  For example, the odds of recent visit(s) to an ancillary therapist were highly elevated among children with autism only (AOR=35.7, 95% CI=22.6-56.5), MR only (AOR=33.1, 95% CI=17.7-61.6), and both conditions (AOR=68.9, 95% CI=24.6-192.5). Likewise, the odds of >9 office visits in the past year were high in children with autism only (AOR=8.3, 95% CI=4.9-14.4), MR only (AOR=14.4, 95% CI=7.1-25.1), and both (AOR=7.8, 95% CI=3.4-18.1). Delayed care was associated with ADHD (AOR= 2.3, 95% CI= 1.8-3.0) and autism/MR (AOR= 3.3, 95% CI= 1.9-5.7). Associations with delayed care were also observed in children with autism only (AOR= 3.6, 95% CI= 1.8-6.6), MR only (AOR= 8.0, 95% CI= 1.1-8.1), and both (AOR= 11.6, 95% CI= 1.2-13.7). Family inability to afford prescriptions was associated with ADHD (AOR= 3.0, 95% CI= 2.1-4.1) and LD/other delay (AOR= 2.7, 95% CI= 1.7-4.1). Among children with and without DDs, NHB children had lower healthcare utilization than NHW children.  However, some estimates among children with individual disabilities were imprecise, and confidence limits included 1.0.

Conclusions:

Children with DDs showed greater use of healthcare and higher prevalence of delayed care. Children with autism or MR had the highest healthcare utilization, 6-37 times higher than children without disabilities, and 2-10 times higher than children with LD/other delay and ADHD. These data inform healthcare planning for this important population subset.