Brief Report: Regional Variations in Characteristics of ASD Hospitalizations in the U.S

Unintentional Drowning Incidents Involving Children with Autism Spectrum Disorder Treated in US Emergency Departments, 2016-2020

Children with autism spectrum disorder (ASD) are at heightened risk of unintentional drowning. We examined the epidemiological patterns of unintentional drowning incidents involving children diagnosed with ASD treated in US emergency departments (EDs). Data for this study came from the 2016-2020 Nationwide ED Sample. Children aged 1-19 years diagnosed with ASD and treated in EDs were identified using ICD-10-CM code F84.0. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of drowning-related ED visits associated with ASD. During the study period, there were an estimated 21,226 unintentional drowning-related ED visits in children, including 369 in children diagnosed with ASD. Compared to children without ASD, ED visits for unintentional drownings in children with ASD were more likely to have occurred in swimming pools (47.45% vs. 41.21%), natural water (15.55% vs. 8.82%), and bathtubs (8.08% vs. 4.79%). Among children with ASD, unintentional drowning-related ED visits occurred more commonly in children > 10 years (43.20% vs. 18.19%) and were more likely to result in hospital admission (35.14% vs. 22.02%) than among children without ASD. With adjustment for demographic characteristics, ASD was associated with more than a 2-fold increased odds of ED-treated unintentional drowning (aOR = 2.31; 95% CI 1.84, 2.89). Epidemiologic patterns of unintentional drowning are different between children with and without ASD. Targeted interventions designed to increase supervision, provide adaptive swimming lessons, and enhance environmental safety may reduce the risk of unintentional drownings among children diagnosed with ASD.

Geographic Variation in Preventable Hospitalizations among US Children with Autism

There is a limited amount of research on geographic differences in preventable hospitalizations for ambulatory care sensitive conditions (ACSCs) among children with autism. The purpose of this study was to examine US regional differences in potentially preventable hospital admissions for pediatric inpatients diagnosed with autism. Hospital discharge data for six pediatric preventable conditions were obtained from the 2016-2019 National Inpatient Sample (NIS) under the US Agency for Healthcare Research and Quality. Geographic differences in preventable hospitalizations for children with autism were examined by US census regions and divisions. Multiple logistic regression analyses were conducted to examine child and clinical characteristics associated with ACSCs hospitalization across four US regions; the dependent variable was the likelihood of ACSCs hospitalization. Additionally, this study further explored the variation in preventable hospitalization among racial and ethnic groups for each region or division. Of the 138,305 autistic inpatients aged 2-17 years, about 10% had a primary diagnosis related to ACSCs. The results showed that the highest proportion of preventable hospitalizations for autistic children occurred in the middle Atlantic division of the northeast region. Racial differences were observed across all US regions, particularly in the northeast and south regions. Black children with autism were more likely to be hospitalized for ACSCs compared to White children with autism in three of the four US regions. Our results highlight the significant racial disparities in potentially avoidable hospitalizations among US children with autism. Examining geographic and racial differences in potentially avoidable hospitalizations could inform policy and practice while gaining a better understanding of pediatric patients with autism and where their families access health services. The findings of this study may help policymakers to identify where intervention is needed to tackle health inequities in the accessibility to quality primary care in the US. Further studies with more detailed investigation are recommended to better understand the mechanisms underlying these disparities, and to formulate effective regional policy and clinical practices while considering the unique needs and challenges of underserved children with autism.