title: Racial and ethnic differences in subspecialty service use by children with autism.
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 = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]).
  
  
  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.
authors.affiliation: Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, and Center for Child and Adolescent Health Research and Policy, Boston, MA, USA. sbroder-finger@partners.org
authors.forename: Sarabeth
authors.initials: S
authors.lastname: Broder-Fingert
authors.forename: Amy
authors.initials: A
authors.lastname: Shui
authors.forename: Christian D
authors.initials: CD
authors.lastname: Pulcini
authors.forename: Daniel
authors.initials: D
authors.lastname: Kurowski
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D001321:Autistic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D009462:Neurology / Q000706:statistics & numerical data; D052756:Nutritional Sciences / Q000706:statistics & numerical data; D016017:Odds Ratio; D011570:Psychiatry / Q000706:statistics & numerical data; D011586:Psychology, Clinical / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: access; autism; diagnosis; racial disparity; specialty care