Funded Projects

Racial Disparities in Hospitalization due to Ambulatory Care Sensitive Conditions among U.S. Children with Autism

Grantee: University of North Carolina at Chapel Hill
Principal Investigator: Wanqing Zhang
Project Number: R41MC42493
Project Date: 9/1/2021

Age group(s)

• Early Childhood (3-5 years)
• Middle Childhood (6-11 years)
• Adolescence (12-18 years)

Targeted/Underserved Population

• African American
• Hispanic/Latino

Abstract

The proposed research addresses HRSA's priority area in addressing health disparities and improving access to quality health care services among underserved children and families. The prevalence of autism spectrum disorder (ASD) has increased dramatically in recent years and affects every race, ethnicity, and socioeconomic status; thus, it requires an adequate and integrated system that supports quality primary care and health equity. Hospitalization for ambulatory care sensitive conditions (ACSCs) has been examined extensively as an indicator of the accessibility and overall effectiveness of primary health care. Families of children with ASD may experience more stress related to unmet primary care needs that may lead to potentially avoidable hospitalizations for ACSCs. Among children with ASD, Hispanics and non-Hispanic Blacks are less likely than non-Hispanic Whites to have a usual source of care and to have had recommended preventive treatments. Little is known about associations between race/ethnicity and preventable hospitalization for ACSCs among children with ASD. To date, no research explores racial differences in ACSCs hospitalization in an inpatient pediatric population with ASD. The proposed study intends to fill this gap through two specific aims: 1) Examine the racial/ethnic trends in the prevalence of hospitalization for ACSCs among children with ASD, and 2) Investigate variations in acute and chronic ACSCs-related hospital stays for children with ASD, by considering race, income strata and geographical region in combination. We will use the US Nationwide Inpatient Sample, a database maintained by the Agency for Healthcare Research and Quality as a part of the Healthcare Cost and Utilization Project, to accomplish these specific aims. Separate sets of regression models will be developed for each hospitalization outcome by examining univariate and multivariate associations with race, income and region. This proposal is unique in its use of the largest, multi-year national dataset to study racial differences in trends, likelihood, characteristics, and determinants of pediatric hospitalization due to ACSCs among children with ASD. A comparative study of preventable hospitalization that crosses racial and income spectrums will provide valuable insight into policy discussions on ASD disparities and health equity of racial/ethnic groups.

Publications

Listed is descending order by year published.

Zhang W, Johnson KR. Geographic Variation in Preventable Hospitalizations among US Children with Autism. Children (Basel). 2023 Jul 15;10(7):1228. doi: 10.3390/children10071228. PMID: 37508725; PMCID: PMC10378360

Zhang, W., Watson, L.R. & Johnson, K.R. Racial Disparities in Hospitalization Due to Ambulatory Care Sensitive Conditions Among U.S. Children with Autism. J Autism Dev Disord (2023).