Unintentional injuries among children with developmental disabilities are a public health challenge in China.

Child injury is a significant global health issue that contributes to both morbidity and mortality in children. Children with developmental disabilities are at a high risk for injuries due to a combination of environmental barriers and health conditions. However, little research has assessed the prevalence of injuries among this population in China. Using administrative data from a micro insurance programme for children with developmental disabilities (such as autism, intellectual disability, cerebral palsy and Down syndrome) under the age of 19, we estimated the risk of unintentional injuries reported in insurance claims. Between 2017 and 2020, there were 190 insurance claims (0.53%) reporting nonfatal unintentional injuries and six reporting fatal injuries. The cumulative hazard rate of unintentional injuries by the end of 1 year is 1.21% and is negatively associated with children's age. These findings suggest the need for increased safety support for children with developmental disabilities, particularly in early childhood.

Transition to adulthood: Dynamics of disability, food security, and SNAP participation.

INTRODUCTION: This study examines how the transition to adulthood may affect food security for individuals with disabilities and estimates the effects of SNAP participation on their food security during the transition. METHODS: The study uses a repeated cross-sectional design with five years of data (2011-2015) from the National Health Interview Survey (NHIS) in the US. The difference-in-difference approach is applied to compare individuals with and without disabilities regarding their food security status in adolescence and young adulthood. Instrumental Variable analyses are conducted using state SNAP policy rules as exogenous instruments to estimate the effects of SNAP participation on food security status for youth and young adults with disabilities. RESULTS: Results indicate that transition into adulthood results in greater food security for individuals without disabilities but an increased risk of low food security for individuals with disabilities. The increased risk for young adults with disabilities may well put them at very low food security, the most severe category on the food security scale. SNAP participation appears to have greater impacts for youth than for young adults. CONCLUSIONS: Since food security likely has a profound impact on the long-term development, economic independence, and self-sufficiency, we discuss a few policy strategies that may help individuals with disabilities in their transition to adulthood.

Food security and health in transition to adulthood for individuals with disabilities.

BACKGROUND: Due to a more stringent disability definition used for eligibility redetermination at age 18, individuals with disabilities may lose eligibility for the Supplement and Nutrition Assistance Program (SNAP). OBJECTIVE: This study examines how the transition to adulthood may affect the association between food security and self-rated health and healthcare needs for individuals with disabilities. METHODS: The study uses five years of data (2011-2015) from the National Health Interview Survey (NHIS). One health indicator, self-rated health status, and two indicators of unmet healthcare needs, delayed medical care and not receiving medical care due to cost, are analyzed as dependent variables. The effects of food security status on health and health-related outcomes are closely examined for the four groups: youth without disabilities, youth with disabilities, young adults without disabilities and young adults with disabilities. RESULTS: Results indicate a statistically significant association between food security status and self-rated health and unmet healthcare needs in late childhood and young adulthood. Such association is stronger for young adults than for youth. The association between low food security and self-rated health and health-related outcomes does not significantly differ between the two youth groups or the two young adult groups by disability status. CONCLUSIONS: Suggestions for improving accessibility of public food and nutrition programs are discussed. The study also suggests the importance of creating a healthcare system that benefits every member of the society.

Changes in health insurance coverage and health care access as teens with disabilities transition to adulthood.

BACKGROUND: Pre-ACA, less than 6% of children with disabilities were uninsured, compared with more than 42% of young adults with disabilities ages 19-25. Individuals with disabilities face greater barriers to health care access upon transition into adulthood. OBJECTIVES: We examined whether the ACA dependent coverage provision and Medicaid expansion improved the transition from pediatric to adult healthcare systems by reducing the gap in insurance coverage and access to care between teens and young adults with disabilities. METHODS: Using cross-sectional data from the 2006-2009 and 2011-2015 National Health Interview Survey (n = 10,136), we estimate the change in insurance coverage and access to care from pre-to post-ACA time periods for teens (ages 13-18) and young adults (ages 19-25) with disabilities in a difference-in-differences model. We completed the same analyses for these groups in Medicaid expansion and non-expansion states. RESULTS: Both teens and young adults with disabilities made significant gains in insurance coverage (4.55 and 8.96% point gains respectively, p < .001) and access to care (4.01 and 3.14% points decline in delayed care due to cost, p < .05) under the dependent coverage provision and Medicaid expansion. CONCLUSIONS: Medicaid expansion had a greater impact on both insurance coverage and on access to care than did the dependent coverage provision. The benefits of these changes flowed primarily to young adults with disabilities, reducing the gaps in insurance coverage between teens and young adults, and expanding access to care for both groups, providing a more seamless transition from pediatric to adult health care systems, post-ACA.

The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs.

OBJECTIVES: We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). METHODS: We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. RESULTS: Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage. CONCLUSIONS: Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.

Affordable Care Act Provision Had Similar, Positive Impacts For Young Adults With And Without Disabilities.

Beginning in 2010 the Affordable Care Act (ACA) allowed young adults (ages 19-25) to remain on their parents' private health insurance plans, even if they were not full-time students. This study investigated the impact of the ACA on health insurance coverage for young adults with disabilities, comparing their experience with that of young adults without disabilities and that of a group of older adults (ages 26-34) with disabilities. We analyzed the periods 2006-09 and 2011-14, which were before and after implementation of the dependent coverage provision in the ACA, respectively. Coverage gains for older adults with disabilities were entirely attributable to changes in public insurance. Gains for young adults overall were driven by changes in private insurance. Both young adults with and without disabilities experienced a 4-percentage-point increase in private health insurance coverage between the two time periods, so the gap in private coverage between the two groups did not change significantly over time. Gains in coverage affected perhaps 2.9 million young adults overall and nearly 300,000 young adults with disabilities.

Medical home and out-of-pocket medical costs for children with special health care needs.

OBJECTIVE: We examined key factors that affect out-of-pocket medical expenditures per $1000 of household income for children with special health care needs (CSHCN) with a broad range of conditions, controlling for insurance type and concentrating on the potentially moderating role of the medical home. METHODS: A Heckman selection model was used to estimate whether the medical home influenced out-of-pocket medical costs per $1000 of household income for children covered by either private or public health insurance. Data from the 2005-2006 National Survey of CSHCN (N = 31,808) were used. RESULTS: For families that incurred out-of-pocket medical costs for their CSHCN, these costs represented 2.2% to 3.9% of income. Both insurance type and the medical home had significant effects on out-of-pocket costs. Lower out-of-pocket medical costs per $1000 of income were incurred by children with public insurance and those receiving care coordination services. CONCLUSIONS: Families with CSHCN incur lower out-of-pocket medical costs when their children receive health care in a setting in which the care-coordination component of the medical home is in place.