title: Change in health status and access to care in young adults with special health care needs: results from the 2007 national survey of adult transition and health.
abstract: BACKGROUND
  Despite over 500,000 adolescents with special health care needs transitioning to adulthood each year, limited information is available on their health status or their access to care after transition.
  
  
  OBJECTIVE
  To describe the change in health status and access to care of a nationally sampled, longitudinal cohort of young adults with special health care needs (ASHCN).
  
  
  METHODS
  We analyzed follow-up data collected in the 2007 Survey of Adult Transition and Health on young adults who were 14-17 years of age when their parents participated in the 2001 National Survey of Children with Special Health Care Needs. We describe changes in access to care and health status over time, and used logistic regression to identify characteristics that were associated with declining health status in this cohort.
  
  
  RESULTS
  1,865 participants, aged 19-23 years, completed the Survey of Adult Transition and Health. Between 2001 and 2007, there was a 3.6 fold increase in the proportion experiencing delayed or forgone care; 10% reported a decline in health status. There was a 7.7-fold increase in the proportion reporting no insurance. In regression analysis, factors associated with declining health status between 2001 and 2007 included underlying disease severity and delayed or forgone care in young adulthood.
  
  
  CONCLUSIONS
  We found significant deterioration in insurance coverage, usual source of care and receiving timely health care as ASHCN aged into adulthood, and that this was associated with decline in health status. Our findings suggest that further population-based analyses of health outcomes are needed to plan for interventions to assist this vulnerable population.
authors.affiliation: Department of Pediatrics, Division of General Pediatrics, University of California, San Francisco, CA 94118, USA. okumuram@peds.ucsf.edu
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
authors.forename: Aimee O
authors.initials: AO
authors.lastname: Hersh
authors.forename: Joan F
authors.initials: JF
authors.lastname: Hilton
authors.forename: Debra S
authors.initials: DS
authors.lastname: Lotstein
mesh_terms: D000293:Adolescent; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D060305:Transition to Adult Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult