Pediatrics · 2025
Disability-Based Discrimination and Forgone Health Care in Children With Special Health Care Needs.
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Ames Stefanie G, Houtrow Amy J, Gatewood Amanda K, Zigler Christy, Ware Allysa, Berry Jay G, Coller Ryan J
Аннотация
BACKGROUND AND OBJECTIVES: Experiences of disability-based discrimination in health care settings can harm patients by limiting access, which may lead to changes in health care use patterns. This study aimed to characterize disability-based discrimination in a nationally representative cohort of children with special health care needs (CSHCN) and evaluate its association with health care use, including forgone care.
METHODS: This cross-sectional study of CSHCN used data from the 2021 and 2022 NSCH. Descriptive statistics compared key respondent demographics by exposure to disability-based discrimination. The primary outcome variable was forgone care in the past 12 months. Secondary outcomes included emergency department (ED) use and hospitalization in the past 12 months. A multivariable logistic regression determined the association of disability-based discrimination and health care use.
RESULTS: In a weighted sample representing 14 million US CSHCN (unweighted n = 24 188), 11.0% experienced disability-based discrimination. Children who experienced discrimination were more likely to have public insurance (42.5% vs 36.8%; P < .001) and have a disability impacting everyday activities compared with those who did not experience discrimination (87.8% vs 59.6%; P < .001). In a multivariable model, disability-based discrimination was associated with an adjusted odds ratio (aOR) of 2.13 (95% CI 1.70-2.65) of experiencing forgone care and an aOR of 1.45 (95% CI 1.16-1.80) of an ED visit in the past 12 months.
CONCLUSIONS: One in 10 CSHCN have experienced discrimination based on their disability. This discrimination is associated with over twice the odds of forgone necessary health care. Addressing disability-based discrimination may help improve health care access.
METHODS: This cross-sectional study of CSHCN used data from the 2021 and 2022 NSCH. Descriptive statistics compared key respondent demographics by exposure to disability-based discrimination. The primary outcome variable was forgone care in the past 12 months. Secondary outcomes included emergency department (ED) use and hospitalization in the past 12 months. A multivariable logistic regression determined the association of disability-based discrimination and health care use.
RESULTS: In a weighted sample representing 14 million US CSHCN (unweighted n = 24 188), 11.0% experienced disability-based discrimination. Children who experienced discrimination were more likely to have public insurance (42.5% vs 36.8%; P < .001) and have a disability impacting everyday activities compared with those who did not experience discrimination (87.8% vs 59.6%; P < .001). In a multivariable model, disability-based discrimination was associated with an adjusted odds ratio (aOR) of 2.13 (95% CI 1.70-2.65) of experiencing forgone care and an aOR of 1.45 (95% CI 1.16-1.80) of an ED visit in the past 12 months.
CONCLUSIONS: One in 10 CSHCN have experienced discrimination based on their disability. This discrimination is associated with over twice the odds of forgone necessary health care. Addressing disability-based discrimination may help improve health care access.