A Population-Based Study of the Health and Economic Burden of Injury on Children with Autism Spectrum Disorders

Injury poses a significant health burden on children as the leading cause of deaths disability and non-fatal Emergency Department (ED) visits among children 1-17 years old [1 2 3]. The National Vital Statistics System estimated that on average more than 1 children die every single hour in our country in 2020 alone [4]. Beyond fatal injuries the CDC estimated that in 2020 3 799 433 U.S. children under 18 years old visited the ED due to non-fatal injuries [4]. Injury also poses a significant economic burden with total cost of injuries among children under 18 reaching $177.40 billion for fatal injuries $40.66 billion for nonfatal hospitalized injuries and $242.76 billion for nonfatal injuries that resulted in ED visits in 2020 [4]. However although risk of injury has been found higher for children with ASD little is known regarding injury-related health and economic burden on top of the already highly stressful ASD-related healthcare management [5-8] and how different subpopulations of the pediatric ASD community were affected by such burdens using large nationally representative population-based databases. The proposed project aims to address this significant gap by investigating disparities in injury-related medical service utilization in children with ASD using 22 years of data from the Medical Expenditure Panel Survey (MEPS) 2000-2021. The specific aims are: (1) To examine and compare national estimates of injury presence and injury-related healthcare service utilization between children with and without ASD and (2) To examine predictive factors of disparities in injury rate and injury-related healthcare service utilization in children with ASD using both conceptually driven and data driven approaches that incorporates cutting-edge machine learning algorithms in feature selection and decision tree analysis. This research is expected to provide scientists clinicians and policymakers with evidence-based data regarding injury-related healthcare disparities to inform development of tailored injury prevention programs for high-risk children with ASD and contribute to continued improvement of healthcare services and delivery of care for U.S. children with ASD. The proposed research aligns with the MCHB Strategic Plan Goal #1 (Assure access to high-quality and equitable health services to optimize health and well-being for all MCH populations) and Goal #2 (Achieve health equity for MCH populations) the MCHB Strategic Research Issue #1 (social determinants of health and health equity) and Issue #2 (quality and ease of access to health resources and services). Findings of the proposed project will also be informative for the Healthy People 2030 Objectives for Injury Prevention including IVP-01 IVP-02 IVP-03 IVP-04 and MICH-03. Finally the proposed research aligns with the Interagency Autism Coordinating Committee's Strategic Plan Objectives under Question 5 (What kind of services and supports are needed to maximize quality of life for people on the autism spectrum?) including Objective #2 (Reduce disparities in access and in outcomes for underserved populations) and Objective #3 (Improve service models to ensure consistency of care across many domains with the goal of maximizing outcomes and improving the value that individuals get from services).