TABLE 3. Health care use, need, and transition planning among adolescent children in the autism spectrum disorder and general population control groups — Study to Explore Early Development, four U.S. sites, 2018–2020*.
| Health care use and need | Autism, % (n = 146) | Control, % (n = 249) | Autism versus control, aPR† (95% CI)§ |
|---|---|---|---|
|
Received health care services in previous 12 mos
| |||
| Preventive check-ups¶ |
89.7 |
96.0 |
0.9 (0.8–1.0) |
| Medical care of any type** |
93.2 |
98.0 |
0.9 (0.9–1.0) |
| Mental health†† |
41.8 |
22.1 |
1.8 (1.3–2.6) |
|
Needed health care services at any time in previous 12 mos but did not receive
| |||
| Health care of any type§§ |
11.0 |
3.2 |
3.1 (1.1–8.8) |
| Medical care of any type¶¶ |
7.5 |
2.0 |
3.4 (1.0–11.8) |
| Mental health***,††† |
7.5 |
3.2 |
2.2 (0.7–6.6) |
|
Health care transition components
§§§
| |||
| Actively worked with doctor or health care provider¶¶¶ |
23.3 |
28.1 |
0.8 (0.5–1.2) |
| Parents know how child will be insured as an adult |
47.7 |
63.5 |
0.8 (0.6–1.0) |
| Child sees doctor or health care provider privately |
38.4 |
66.3 |
0.6 (0.5–0.8) |
|
Health care transition components met
§§§
| |||
| Met all three components |
7.5 |
14.1 |
0.7 (0.3–1.5) |
| Met two or more components |
30.8 |
57.0 |
0.6 (0.4–0.8) |
| Met zero or one component | 69.2 | 43.0 | 1.5 (1.2–1.9) |
Abbreviations: aPR = adjusted prevalence ratio; CI = confidence interval.
* Survey data were collected from four sites in Georgia, Maryland, North Carolina, and Pennsylvania as part of a preliminary follow-up study of parents or guardians of adolescents aged 12–16 years who were enrolled in the Study to Explore Early Development (https://www.cdc.gov/ncbddd/autism/seed.html) at ages 2–5 years and initially identified as having autism (autism group) or as general population controls (control group).
† aPRs were estimated using a modified Poisson regression with robust standard error (https://doi.org/10.1093/aje/kwh090) and study group (autism or control) as the predictor, adjusted for maternal education, maternal country of birth (born inside or outside the United States), adolescent sex (male or female), adolescent race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic other, or Hispanic), household income as a percentage of federal poverty level, and insurance type (private, public, both, or neither); data on maternal and paternal race/ethnicity that were collected during the original Study to Explore Early Development were used in combination to assign adolescent race/ethnicity.
§ aPRs were considered significant when the 95% CI did not include the null value of 1.
¶ One or more preventative check-ups in the previous 12 months.
** Includes any visit to a doctor, nurse or other health care provider for sick-child care, preventive check-ups, physical exams, hospitalizations, or any other medical care.
†† Includes adolescents whose parents affirmed that they had received treatment or counseling from a mental health professional in the previous 12 months.
§§ Includes adolescents whose parents reported that they needed health care of any type in the previous 12 months but did not receive it. Health care of any type includes medical, dental, vision, hearing, and mental health care.
¶¶ Includes adolescents whose parents affirmed the types of care that they specifically needed (i.e., medical, dental, vision, or hearing care) in the previous 12 months but did not receive it.
*** Includes adolescents whose parents indicated that they needed treatment or counseling from a mental health professional but did not receive it.
††† Data missing from one participant in the autism group.
§§§ Adolescents met the National Performance Measure of the Health Resources and Services Administration Maternal and Child Health Bureau (https://mchb.tvisdata.hrsa.gov/PrioritiesAndMeasures/NationalPerformanceMeasures) if all three elements of the health care transition measure (https://doi.org/10.1007/s10995-019-02858-6) were met.
¶¶¶ This element comprised four indicators. Parents were asked whether their child’s doctors or primary care providers actively worked with the child to 1) think about and plan for his/her future; 2) make positive choices about his/her health; 3) gain skills to manage his/her health and health care; and 4) understand the changes in health care that happen at age 18 years. To meet criteria for this component, the adolescent’s parent had to endorse at least three of four indicators.