title: Inpatient and emergency room visits for adolescents and young adults with spina bifida living in South Carolina.
abstract: OBJECTIVE
  To compare emergency room (ER) and inpatient hospital (IP) use rates for persons with spina bifida (SB) to peers without SB, when transition from pediatric to adult health care is likely to occur; and to analyze those ER and IP rates by age, race, socioeconomic status, gender, and type of residential area.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Secondary data analysis in South Carolina.
  
  
  METHODS
  We studied individuals who were between 15 and 24 years old and enrolled in the State Health Plan (SHP) or state Medicaid during the 2000-2010 study period.
  
  
  METHODS
  Individuals with SB were identified using ICD-9 billing codes (741.0, 741.9) in SHP, Medicaid, and hospital uniform billing (UB) data. ER and IP encounters were identified using UB data. Multivariable Generalized Estimating Equation (GEE) Poisson models were estimated to compare rates of ER and IP use among the SB group to the comparison group.
  
  
  METHODS
  Total ER rate and IP rate, in addition to cause-specific rates for ambulatory care sensitive conditions (ACSC) and other condition categories.
  
  
  RESULTS
  We found higher rates of ER and IP use in persons with SB compared to the control group. Among individuals with SB, young adults (those 20-24 years old) had higher rates of ER use due to all ACSC (P = .023), other ACSC (P = .04), and urinary tract infections (UTI; P = .002) compared to adolescents (those 15-19 years old).
  
  
  CONCLUSIONS
  Young adulthood is associated with increased ER use overall, as well as in specific condition categories (most notably UTI) in individuals 15-24 years old with SB. This association may be indicative of changing healthcare access as people with SB move from adolescent to adult health care, and/or physiologic changes during the age range studied.
authors.affiliation: Department of Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Drive, Columbia, SC 29203(∗). Electronic address: joshua.mann@uscmed.sc.edu.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Mann
authors.affiliation: South Carolina Revenue and Fiscal Affairs Office, Columbia, SC(†).
authors.forename: Julie A
authors.initials: JA
authors.lastname: Royer
authors.affiliation: Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Columbia, SC(‡).
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Turk
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(§).
authors.forename: Suzanne
authors.initials: S
authors.lastname: McDermott
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(‖).
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Holland
authors.affiliation: Department of Economics University of South Carolina Darla Moore School of Business, Columbia, SC(¶).
authors.forename: Orgul D
authors.initials: OD
authors.lastname: Ozturk
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC(#).
authors.forename: James W
authors.initials: JW
authors.lastname: Hardin
authors.affiliation: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA(∗∗).
authors.forename: Judy K
authors.initials: JK
authors.lastname: Thibadeau
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D013022:South Carolina / Q000453:epidemiology; D016135:Spinal Dysraphism / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult