2
|
Li C, He WQ. Prevalence and treatment of autism spectrum disorder in the United States, 2016-2022. Autism Res 2024. [PMID: 39221608 DOI: 10.1002/aur.3228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
This study aims to assess the prevalence of Autism Spectrum Disorder (ASD) and its treatment. The study population was children aged 3-17 years with information on current ASD from National Survey of Children's Health, 2016-2022. Analysis of treatment was also conducted within the population of children with a current ASD diagnosis. A multivariate log-binomial regression model was used to assess the change of current ASD prevalence and ASD treatment by two study period (prior to COVID-19 pandemic: 2016-2019; during COVID-19 pandemic: 2020-22) and sociodemographic information. Compared to the current ASD at 2.5% in 2016, it increased to 3.6% in 2022. The treatment has decreased from 70.5% in 2016 to 61.6% in 2022 for any treatment and from 27.2% in 2016 to 20.4% in 2022 for medication treatment. Compared to children from 2016-2019, children from the following group were more likely to have ASD diagnosis during the pandemic (2020-2022), including those aged 3-5 years (aPR = 1.66, 95%CI 1.29-2.13), non-Hispanic white children, children from family with above national family income, and those with private insurance. However, medication treatment almost halved during the pandemic for non-Hispanic black children (aPR = 0.49, 95%CI 0.26-0.93) and children born overseas. In conclusion, higher prevalence of ASD might indicate a better awareness of ASD. The reduction in treatment correlates to the health service disruption caused by the pandemic, highlighting the needs of policy efforts to improve treatment for ASD.
Collapse
Affiliation(s)
- Chenxi Li
- Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wen-Qiang He
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Brewster RCL, Azad AD, Acosta K, Starmer A, Sprecher E, Rea C, Gray KP, Regan S, Wilson J, Bayuh F, Buncher N, Hauptman M. Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels. Acad Pediatr 2024; 24:810-814. [PMID: 37979935 DOI: 10.1016/j.acap.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels. METHODS A retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019-March 9, 2020) and COVID-19 (March 10, 2020-March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression. RESULTS Among a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53-0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35-2.20; aOR 2.58, 95% CI 2.13-3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020-March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87-2.53; COVID-19: aOR 3.51, 95% CI 1.98-6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35-2.20; COVID-19: aOR 2.56, 95% CI 1.95-3.34; interaction P value .034). CONCLUSIONS The COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.
Collapse
Affiliation(s)
- Ryan C L Brewster
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster and N Buncher), Boston Medical Center, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass.
| | - Amee D Azad
- Department of Ophthalmology (AD Azad), Massachusetts Eye and Ear, Boston, Mass
| | - Keith Acosta
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass
| | - Amy Starmer
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass
| | - Eli Sprecher
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass
| | - Corinna Rea
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass
| | - Kathryn P Gray
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Institutional Centers of Clinical and Translational Research (KP Gray), Boston Children's Hospital, Boston, Mass
| | - Shannon Regan
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass
| | - Joseph Wilson
- Harvard T.H. Chan School of Public Health (J Wilson), Boston, Mass
| | - Frehiwot Bayuh
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass
| | - Noah Buncher
- Department of Pediatrics (RCL Brewster and N Buncher), Boston Medical Center, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (N Buncher and M Hauptman), Boston, Mass
| | - Marissa Hauptman
- Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (N Buncher and M Hauptman), Boston, Mass
| |
Collapse
|
4
|
Michels SY, Daley MF, Newcomer SR. Completion of multidose vaccine series in early childhood: current challenges and opportunities. Curr Opin Infect Dis 2024; 37:176-184. [PMID: 38427536 PMCID: PMC11210715 DOI: 10.1097/qco.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. RECENT FINDINGS Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. SUMMARY Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.
Collapse
Affiliation(s)
- Sarah Y. Michels
- Center for Population Health Research, University of Montana, Missoula, Montana
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sophia R. Newcomer
- Center for Population Health Research, University of Montana, Missoula, Montana
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| |
Collapse
|
5
|
Cook N, McGrath BM, Navale SM, Koroukian SM, Templeton AR, Crocker LC, Zyzanski SJ, Bensken WP, Stange KC. Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022). J Am Board Fam Med 2024; 36:916-926. [PMID: 37857445 PMCID: PMC10843627 DOI: 10.3122/jabfm.2023.230081r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. OBJECTIVE To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). METHODS We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. RESULTS There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. CONCLUSION Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.
Collapse
Affiliation(s)
- Nicole Cook
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS).
| | - Brenda M McGrath
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Suparna M Navale
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Siran M Koroukian
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Anna R Templeton
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Laura C Crocker
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Stephen J Zyzanski
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Wyatt P Bensken
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| | - Kurt C Stange
- From the OCHIN, Inc., Portland, OR (NC, BMM, SMN, ART, LCC, WPB, KCS); Case Western Reserve University, Cleveland, OH (SMK, SJZ, KCS)
| |
Collapse
|
6
|
Panteli D, Mauer N, Tille F, Nimptsch U. How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data. BMC Health Serv Res 2023; 23:938. [PMID: 37653471 PMCID: PMC10472716 DOI: 10.1186/s12913-023-09929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further. METHODS Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy. RESULTS Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves. CONCLUSIONS Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.
Collapse
Affiliation(s)
- Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium.
| | - Nicole Mauer
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium
| | - Florian Tille
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Cowdray House, London, WC2A 2AE, UK
| | - Ulrike Nimptsch
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
| |
Collapse
|