506 - Healthcare Access, Family Stress, and Comorbidities Among US Children with Intellectual Disability: A 2016-2023 Analysis of the National Survey of Children’s Health

Publication Number: 1486.506

Michael O. Sohn, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Rahul Burra, Northwestern University The Feinberg School of Medicine, 333 E Ontario st, IL, United States; Arun K. Movva, Northwestern University The Feinberg School of Medicine, 60610, IL, United States; Rishi K. Agrawal, Lurie and La Rabida Children's hospitals, CHICAGO, IL, United States; Carolyn Foster, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Children with intellectual disabilities (IDs) represent a particularly vulnerable health care population, enduring comorbid conditions as well as making visits to the hospital and ED at significantly increased rates relative to their peers. While these differences exist, there has been minimal investigation into the driving factors behind this imbalance, such as primary care utilization, access to specialists, and home stability.

Objective: We sought to perform an updated, large-scale data analysis examining disparities in resource utilization and home stability among children with IDs as compared to their peers to better understand the current healthcare landscape for this population.

Design/Methods: Data was drawn from the National Survey of Children's Health (NSCH), an annual federal survey on the physical and emotional health of US children. The 2016-2023 dataset permits stratification of responses from children or youth with special health care needs (CYSHCN) by the presence or absence of ID, allowing for a comparison of the demographics, resource utilization, and home stability of these populations across a series of metrics. Differences in categorical variables (e.g. demographics) were evaluated using Chi-squared tests. Logistic regression models controlling for age, sex, language, and insurance status were used to calculate odds ratios (ORs) for binary outcomes such as specialist utilization and indicators of household stability.

Results: Weighted analyses included 729,810 CYSHCN with IDs and 13,272,722 CYSHCN without IDs - demographic information is available in Table 1. Children with IDs had no significant differences in primary care utilization though did report decreased rates of eye and dental care in addition to increased interfacing with mental healthcare and special therapies (Table 2). However, children with IDs were more likely to report having needed care and not received it. Additionally, these children were more likely to report having felt unsafe at school or home, and their families were more likely to have experienced financial or emotional strain, including difficulty paying medical bills, reduced work hours for caregiving, challenges in care coordination, or food assistance utilization (Table 3).

Conclusion(s): While children with IDs do not appear to face reduced access to primary care or special therapies, their increased prevalence of socioeconomic instability may contribute to increased emergent health care use and comorbidities. Targeted interventions addressing care coordination and family financial support are essential to improving outcomes and equity for this population.

Table 1. Demographics of CYSCHCN with and without IDs


Table 2. Healthcare Utilization, Specifically Primary Care Access and Specialty Care Utilization, by CYSCHCN with and without IDs
*In Table 2, multivariate analysis controlled for age, sex, language, and insurance status

Table 3. Household Emotional and Financial Well-Being in CYSCHCN with and without IDs
*In Table 3, multivariate analysis controlled for age, sex, language, and insurance status