Disparities in Healthcare Access and Utilization among Children with Autism Spectrum Disorder from Immigrant Non-English Primary Language Households in the United States

Abstract

Background:The prevalence of autism spectrum disorder (ASD) in United State (US) has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment.Methods:We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening.Results:Approximately, 28% of parents of children with ASD from non-English primary language (NEPL) households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL) households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator.Conclusions and Global Health Implications:Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of ASD has increased worldwide, understanding of the condition and care-seeking behavior in migrant populations is especially valuable.

A Scoping Review of Health Disparities in Autism Spectrum Disorder

“…The nine included studies (Broder-Fingert et al 2013; Doshi et al 2017; Lin and Yu 2015; Liptak et al 2008; Magaña et al 2012; Magaña et al 2015; Parish et al 2012; Tint et al 2017; Zhang et al 2017) shared a number of methodological characteristics. Eight studies were cross-sectional (Broder-Fingert et al 2013; Lin and Yu 2015; Liptak et al 2008; Magaña et al 2012; Magaña et al 2015; Parish et al 2012; Tint et al 2017; Zhang et al 2017), and one (Doshi et al 2017) used panel data to estimate a longitudinal effect using a difference-in-difference-indifference estimation technique.…”

“…Eight studies were cross-sectional (Broder-Fingert et al 2013; Lin and Yu 2015; Liptak et al 2008; Magaña et al 2012; Magaña et al 2015; Parish et al 2012; Tint et al 2017; Zhang et al 2017), and one (Doshi et al 2017) used panel data to estimate a longitudinal effect using a difference-in-difference-indifference estimation technique. One (Magaña et al 2015) of the eight cross-sectional studies followed up on a question posed in a previous wave of data collection, although participants were not linked across waves of data collection and data were analyzed cross-sectionally.…”

“…One (Magaña et al 2015) of the eight cross-sectional studies followed up on a question posed in a previous wave of data collection, although participants were not linked across waves of data collection and data were analyzed cross-sectionally. Most included studies also used the same dataset: five studies (Doshi et al 2017; Lin and Yu 2015; Magaña et al 2012; Magaña et al 2015; Parish et al 2012) used data from the National Survey of Children with Special Health Care Needs. Two of the remaining four studies used other secondary datasets (Liptak et al 2008; Zhang et al 2017), while one study (Tint et al 2017) used prospectively collected survey data and another (Broder-Fingert et al 2013) used data from a hospital research registry.…”

“…In terms of disparity categories (i.e., racial disparities), seven (Broder-Fingert et al 2013; Doshi et al 2017; Liptak et al 2008; Magaña et al 2012; Magaña et al 2015; Parish et al 2012; Tint et al 2017) examined disparities in only one category. The studies that we identified examined disparities in access to general medical services related to race ( n = 7 ; Broder-Fingert et al 2013; Doshi et al 2017; Lin and Yu 2015; Liptak et al 2008; Magaña et al 2012; Magaña et al 2015; Parish et al 2012), socioeconomic status ( n = 2 ; Lin and Yu 2015; Liptak et al 2008), sex ( n = 1 ; Tint et al 2017), and geography ( n = 1 ; Zhang et al 2017). No studies examined disparities related to ethnicity, culture, or gender identity.…”

“…Seven of the nine included studies identified disparities related to race (Magaña et al 2012; Parish et al 2012; Broder-Fingert et al 2013; Lin and Yu 2015; Magaña et al 2015; Doshi et al 2017; Liptak et al 2008), and six of seven studies found evidence for racial disparities in health care access and quality for African American and Latino children with ASD.…”