Evaluating Disparities in the Utilisation of Therapy Services for Children With Down Syndrome Through a Deidentified Medicaid Data Set.

Background: The objective of this retrospective observational study was to examine disparities in health care utilisation for children with Down syndrome (DS).

Methods: Outpatient Medicaid claims from 2016 to 2018 were used to examine the utilisation of therapy services and annual Medicaid payments for children with DS based on sex, race and age. Multilevel logistic regression was used to analyse the relationship of therapy utilisation with sex, race and age. Gamma-distributed log link model was used to analyse the relationship between annual Medicaid payments and race.

Results: The cohort consisted of 17 813 children with DS aged 21 and under. There was no significant difference in utilisation of therapy services between sexes. The likelihood of receiving therapy services decreased for Black or other race individuals compared to White. White individuals had higher annual Medicaid payments than Black or other race individuals. The likelihood of receiving therapy services increased for children 3-17 years old when compared to children aged 0-2 years old.

Discussion: There are significant disparities in therapy utilisation for children with DS related to race and age. Increased annual Medicaid payments for White individuals may indicate that they are receiving more outpatient services than the Black/other populations. Decreased therapy utilisation for ages 18-21 years corresponds with the transition to adulthood. The decreased likelihood of receiving therapy services for ages 0-2 is concerning due to the importance of early intervention. Further research is needed to evaluate factors contributing to disparities in outpatient utilisation for children with DS.