WHAT'S KNOWN ON THIS SUBJECT: Racial and ethnic differences exist in age at diagnosis and early access to mental and behavioral health services among children with autism spectrum disorders (ASDs). ASDs are also associated with increased rates of other medical comorbidities that may require specialty care.WHAT THIS STUDY ADDS: Significant racial and ethnic differences in use of specialty care and specialty procedures exist among children with documented ASD. abstract OBJECTIVE: To describe racial differences in use of specialty care among children with autism spectrum disorder. METHODS:We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type. RESULTS:We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0. CONCLUSIONS:We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through. Pediatrics 2013;132:94-100

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Objective: Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury. Methods:This was a retrospective cohort study of children 0 to 18 years with ICD-9/ ICD-10 diagnosis codes for firearm injury (excluding nonpowder) in the emergency department or inpatient setting from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included: (1) difference in health care encounters for 1 year before and 1 year after injury, (2) difference in health care expenditures, and(3) difference in complex chronic disease status. Descriptive statistics characterized patient demographics and health care utilization. Health expenditures were evaluated with Wilcoxon signed-rank tests.Results: Among 1,821 children, there were 22,398 health care encounters before the injury and 28,069 after. Concomitantly, there was an overall increase of $16.5 million in health expenditures ($9,084 per patient). There was a 50% increase in children qualifying for complex chronic condition status after firearm injury. Conclusions:Children who experience nonfatal firearm injury have increased number of health care encounters, chronic disease classification, and health care expenditures in the year following the injury. Prevention of firearm injuries in this vulnerable age group may result in considerable reductions in morbidity and health care costs.

OBJECTIVES:For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to: (1) describe percent increases in parent-reported lifetime prevalence and comorbidity over time and how these vary by socioeconomic status and (2) examine the extent poverty status is a predictor of higherthan-average comorbidities.METHODS: Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent-reported prevalence and comorbid chronic health conditions from a list provided in the survey among children with asthma, ADHD, and ASD, and we examined variation by sociodemographic characteristics and insurance coverage. By using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher-than-average comorbid conditions after adjusting for other sociodemographic characteristics.RESULTS: Parent-reported lifetime prevalence of asthma and ADHD between 2003 and 2011-2012 rose 21% and 43%, respectively, whereas the parent-reported prevalence of ASD rose 32% between 2007 and 2011-2012. The percent increase in asthma was higher among girls and uninsured children. For ADHD, the rise in parent-reported prevalence only varied by age. Being poor was associated with nearly twice the adjusted odds (adjusted odds ratio = 1.72) of having at least 1 comorbidity among children with asthma and more than twice the adjusted odds (adjusted odds ratio = 2.60) of having at least 2 comorbidities among children with ADHD. CONCLUSIONS:Poverty status differentially influenced parent-reported lifetime prevalence of comorbidities for these target disorders. Future research is needed to examine how poverty influences lack of access and chronic stress and exposure on children to induce comorbidities, especially mental disorders. Dr Pulcini aided in the conceptualization of the study, drafted the initial manuscript, and reviewed and revised the manuscript; Drs Zima and Kelleher aided in conceptualization of the study and critically reviewed and revised the manuscript; Dr Houtrow conceptualized and designed the study and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. What's KnOWn On thIs subject: Children in poverty with chronic conditions are more likely to have higher rates of comorbid disorders and worse outcomes than those not in poverty. DOI What thIs stuDy aDDs:The relationship between poverty and comorbid health conditions differs for children with asthma, attention-deficit/hyperactivity disorder, and autism. 6 and a National Academies of Sciences, Engineering, and Medicine 7 report that recognized the challenges in identifying comorbidities among children receiving SSI benefits. 8 However, no data to our knowledge have been published utilizing national data sets to estimate the prevalence of common chronic health conditions and comorbidities among those in poverty utilizing income data as a potential proxy for SSI recipient ...

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