A Profile on Emergency Department Visits in Adolescents with Autism Spectrum Disorders
Objectives: In this study, we use a large, national healthcare claims database to compare the healthcare utilization history (in-/out-patient medical records) of adolescents with and without ASD, with a focus on emergency department (ED) visits. The goal of this study is to provide an understanding of the physical and mental health well-being of adolescents with ASD.
Methods: Using the healthcare claims data from MarketScan®, we identified subjects aged 12-21 during each year of 2005-2013. In each annual cohort, we constructed an ASD cohort of adolescents with at least two separate diagnoses of ASD (ICD 9 codes 299.0x and 299.8x) through the entire study period (2005-2013) and a non-ASD cohort of those without ASD diagnosis during the study period. We constructed the following annual measures: (a) proportion of adolescents with ASD having ED visit ; (b) proportion of adolescents without ASD having ED visit; (c) proportion of urban adolescents with ASD having ED visit; (d) proportion of rural adolescents with ASD having ED visit; (e) proportion of adolescents having a behavioral ED visit among those non-ASD adolescents with any ED visits; and (f) proportion of adolescents having a behavioral ED visit among those ASD adolescents with any ED visits.
Results: We observed a consistent increase in the percentage of ASD patients among all adolescents who visited emergency department, from 0.28% in 2005 to 0.85% by 2013. While the percentage of subjects in non-ASD cohort who had ED visits have been fairly stable at around 3%, the percentage in ASD cohort steadily increased from 3.1% in 2005 to 15.8% by 2013. Although rural adolescents with ASD showed a similar pattern in ED visit to those living in urban areas, it took a sharp jump from 14.9% in 2012 to 18.5% in 2013, compared to 16% among urban adolescents with ASD. Among subjects with ED visits, behavioral health service-related ED visits increased from 11.9% in 2005 to 21.6% by 2013 among adolescents with ASD, compared to a more modest increase from 2.6% to 5.9% among adolescents without ASD.
Conclusions: Our study showed a disconcerting increase in the proportion of adolescents with ASD who had ED visits over the recent decade or so. We also observed a drastic increase in ED visits primarily associated with behavioral health service, suggesting an ASD-related mental health crisis. Finally, adolescent ASD patients living in rural areas experienced a large increase in ED visits, suggesting that this may be a particularly vulnerable population.