61 - Experience of Racism in Children with Autism and Associations with Health Outcomes

Poster Number: 61
Publication Number: 61.202

Emma Fleisher, Tufts University School of Medicine, Chicago, IL, United States; Christina Sakai, Tufts Childrens Hospital, Boston, MA, United States; Kyle M. Monahan, Tufts University, Somerville, MA, United States

Background:
Perceived racism has been associated with poor physical, mental, and behavioral health outcomes. While perceived racism has clear impacts on child health, the experience of racism on particularly vulnerable populations has not yet been characterized.

Objective: To study the associations of perceived racism with healthcare access, quality of care, and health outcomes among children with autism spectrum disorder (ASD).

Design/Methods: Using data from the 2018 and 2019 National Survey of Children’s Health, we compared experienced racism in children with ASD versus those without ASD. Bivariate analyses compared sociodemographic factors and healthcare factors in families of children with ASD who reported experiencing racism versus those who reported never experiencing racial discrimination. The experience of racism variable was derived from a question asking caregivers whether their child has been, “treated or judged unfairly because of his/her race or ethnic group.” Logistic regression analyses were used to study associations of racism with healthcare access (receipt of services, age of service initiation, difficulties obtaining care); quality of care (shared decision making, usual source of care, time spent with provider in preventative care, care coordination, family-centered care); and health outcomes (age of autism diagnosis, severity).

Results:
Children with ASD had a higher frequency of perceived racism than children without ASD (8.5% vs. 4.9% , p=0.01). Among children with ASD, age, race, insurance status, income level, and family structure had significant differences between children who experienced racism and those who did not. Racism was significantly associated with the following measures of healthcare access, quality, and health outcomes: currently receiving developmental services (aOR 0.30; 95% CI 0.11-0.79); initiated services before 5 years old (aOR 0.28; 95% CI 0.09-0.86); received needed mental health care (aOR 0.18; 95% CI 0.04-0.81); has special education or early intervention plan (aOR 0.23; 95% CI 0.10-0.55); less than 10 minutes spent in a preventative health visit (aOR 4.75; 95% CI 1.14-19.83).
Conclusion(s): Study results determined that children with ASD experience racism at a higher frequency than children without ASD. Among children with ASD, the experience of racism was associated with deteriorations in healthcare quality and access.
Emma Fleisher CV.pdf