Mohammad Asghari Jafarabadi1,2, Kamal Gholipour3, Hassan Shahrokhi4, Ayyoub Malek4, Akbar Ghiasi5, Hamid Pourasghari6, Shabnam Iezadi7. 1. Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran. 2. Center for the Development of Interdisciplinary Research in Islamic Sciences, and Health Sciences Tabriz University of Medical Sciences, Tabriz, Iran. 3. Social Determinants of Health Research Center, Tabriz University of Medical Science, Tabriz, Iran. 4. Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran. 5. HEB School of Business & Administration, University of the Incarnate Word, San Antonio, TX, USA. 6. Hospital Management Research Center, Iran University of Medical Science, Tehran, Iran. 7. Hospital Management Research Center, Iran University of Medical Science, Tehran, Iran. sh_iezadi@yahoo.com.
Abstract
BACKGROUND: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. METHODS: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2-16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. RESULTS: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464-0.704) and access (B: 0.265-0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant. CONCLUSIONS: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.
BACKGROUND: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. METHODS: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2-16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. RESULTS: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464-0.704) and access (B: 0.265-0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant. CONCLUSIONS: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.
Entities:
Keywords:
Access; Autism Spectrum disorders; Disparities; Quality; Social determinants of health; Structural equation modeling
Authors: Michael D Kogan; Bonnie B Strickland; Stephen J Blumberg; Gopal K Singh; James M Perrin; Peter C van Dyck Journal: Pediatrics Date: 2008-12 Impact factor: 7.124
Authors: David S Mandell; Lisa D Wiggins; Laura Arnstein Carpenter; Julie Daniels; Carolyn DiGuiseppi; Maureen S Durkin; Ellen Giarelli; Michael J Morrier; Joyce S Nicholas; Jennifer A Pinto-Martin; Paul T Shattuck; Kathleen C Thomas; Marshalyn Yeargin-Allsopp; Russell S Kirby Journal: Am J Public Health Date: 2008-12-23 Impact factor: 9.308