Utilisation des services de santé chez les jeunes autistes en Aotearoa Nouvelle-Zélande : une étude transversale nationale

Titre original en anglais : Health service utilization among autistic youth in Aotearoa New Zealand: A nationwide cross-sectional study

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McLay, L., Schlüter, P. J., Williams, J., Anns, F., Monk, R., Dacombe, J., Hogg, G., Tupou, J., Ruhe, T., Scott, T., Woodford, E., Thabrew, H., & Bowden, N. (2024). Health service utilization among autistic youth in Aotearoa New Zealand: A nationwide cross-sectional study. Autism, 29(5), 1143-1156. https://doi.org/10.1177/13623613241298352

Date de publication: 03/12/2024 Ajout dans AutiHub: 05/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
13
Auteur·ices de la publication identifié·es comme autistes
2 / 13 (15,4 %)
  1. Laurie McLay
  2. Philip J. Schlüter
  3. John Williams
  4. Francesca Anns
  5. Ruth Monk *
  1. Joanne Dacombe
  2. Gabrielle Hogg *
  3. Jessica Tupou
  4. Troy Ruhe
  5. Taylor Scott
  1. Emma Woodford
  2. Hiran Thabrew
  3. Nicholas Bowden

Résumé

De nombreux jeunes autistes ont des besoins de santé complexes, ce qui entraîne des taux élevés d'utilisation des services de santé. Cependant, de nombreuses caractéristiques de cette utilisation des services de santé restent inconnues. À l'aide de données portant sur l'ensemble de la population, cette étude visait à quantifier et à comparer les taux d'utilisation des services de santé psychiatriques et non psychiatriques chez les jeunes autistes et non autistes, avec et sans déficience intellectuelle concomitante. Une étude de cohorte rétrospective nationale a été menée à l'aide de données administratives individuelles appariées concernant les jeunes d'Aotearoa Nouvelle-Zélande (âgés de 0 à 24 ans). Les critères de jugement relatifs à l'utilisation des services de santé comprenaient 11 domaines psychiatriques et non psychiatriques. Un appariement par score de propension sur un ensemble de mesures sociodémographiques a permis de comparer les groupes quant aux critères de jugement relatifs à l'utilisation des services de santé. Des données ont été obtenues pour 19 479 jeunes autistes, dont 29 % présentaient une déficience intellectuelle concomitante, et 1 561 278 jeunes non autistes. Les résultats ont montré des taux plus élevés d'utilisation des services de santé mentale chez les jeunes autistes par rapport aux jeunes non autistes, y compris le recours à des services hospitaliers (ratio de prévalence 5,85 ; intervalle de confiance à 95 % 4,93-6,94) et ambulatoires (ratio de prévalence 4,96 ; intervalle de confiance à 95 % 4,75-5,18), ainsi que la délivrance de médicaments psychotropes (ratio de prévalence 6,83 ; intervalle de confiance à 95 % 6,65-7,02), en particulier chez les jeunes autistes sans déficience intellectuelle. Les taux d'admissions hospitalières non psychiatriques (ratio de prévalence 1,93 ; intervalle de confiance à 95 % 1,85-2,01), d'hospitalisations potentiellement évitables (ratio de prévalence 1,91 ; intervalle de confiance à 95 % 1,82-2,00) et de consultations ambulatoires (ratio de prévalence 1,99 ; intervalle de confiance à 95 % 1,95-2,01) étaient également plus élevés chez les jeunes autistes. Les implications pour la recherche concernant la prestation des services de santé sont examinées. Résumé grand public Les jeunes autistes utilisent généralement les services de santé plus souvent que les jeunes non autistes. Cependant, nous savons très peu de choses sur les facteurs pouvant influer sur l'utilisation des services de santé et sur les types de services utilisés, et cela n'a pas été étudié en Aotearoa Nouvelle-Zélande. Nous avons analysé des données de Nouvelle-Zélande afin de comparer l'utilisation des services de santé chez les jeunes autistes et non autistes (âgés de 0 à 24 ans). Des données étaient disponibles pour 19 479 jeunes autistes et 1 561 278 jeunes non autistes. Nous avons comparé les hospitalisations, les consultations de spécialistes, les consultations aux urgences et l'utilisation de différents types de médicaments. Dans cette étude, il a été constaté que les jeunes autistes avaient été hospitalisés pour des raisons médicales et de santé mentale plus souvent que les jeunes non autistes. Les jeunes autistes étaient également plus susceptibles d'avoir eu des rendez-vous avec des spécialistes et d'avoir reçu des médicaments. Ces différences étaient particulièrement importantes pour les médicaments couramment utilisés pour des troubles de santé mentale, par exemple l'anxiété, la dépression et le trouble déficitaire de l'attention avec hyperactivité, ou pour des symptômes associés. Les jeunes autistes qui présentaient également une déficience intellectuelle étaient plus susceptibles d'utiliser les services de santé pour des affections de santé physique, mais moins susceptibles d'utiliser les services de santé mentale, comparativement aux jeunes autistes qui ne présentaient pas de déficience intellectuelle. Ces résultats, ainsi que d'autres recherches, suggèrent que les besoins de santé des jeunes autistes ne sont pas toujours satisfaits. Des travaux supplémentaires sont nécessaires pour améliorer notre compréhension des affections concomitantes chez les jeunes autistes, y compris celles qui entraînent des taux élevés d'utilisation des services de santé, afin d'éclairer l'élaboration de services de santé et la formation des professionnels de santé pour mieux répondre aux besoins des jeunes autistes.

Many autistic youth have complex healthcare needs, resulting in high rates of health service utilization. However, many characteristics of this health service utilization remain unknown. Using whole-of-population data, this study aimed to quantify and compare rates of psychiatric and non-psychiatric health service utilization among autistic and non-autistic youth, with and without co-occurring intellectual disability. A national retrospective cohort study was employed using linked individual-level administrative data for Aotearoa New Zealand youth (aged 0-24 years). Health service utilization outcomes included 11 psychiatric and non-psychiatric domains. Propensity score matching on a range of sociodemographic measures compared groups across health service utilization outcomes. Data were obtained for 19,479 autistic youth, 29% of whom had a co-occurring intellectual disability and 1,561,278 non-autistic youth. Results demonstrated higher rates of mental health service utilization among autistic compared with non-autistic youth, including inpatient (prevalence ratio 5.85; 95% confidence interval 4.93-6.94) and outpatient (prevalence ratio 4.96; 95% confidence interval 4.75-5.18) service use and psychotropic medication dispensing (prevalence ratio 6.83; 95% confidence interval 6.65-7.02), particularly among autistic youth without intellectual disability. Rates of non-psychiatric hospital admissions (prevalence ratio 1.93; 95% confidence interval 1.85-2.01), potentially avoidable hospitalizations (prevalence ratio 1.91; 95% confidence interval 1.82-2.00) and outpatient visits (prevalence ratio 1.99; 95% confidence interval 1.95-2.01) were also higher among autistic youth. Research implications for delivery of healthcare services are discussed.Lay abstractAutistic youth generally use healthcare services more often than non-autistic youth. However, we know very little about the factors that can affect health service use and the types of services that are used, and this has not been explored in Aotearoa New Zealand. We analysed data from New Zealand to compare health service use among autistic and non-autistic youth (0 to 24-year-olds). Data were available for 19,479 autistic youth and 1,561,278 non-autistic youth. We compared hospitalizations, specialist visits, emergency department visits and use of different types of medications. In this study, autistic youth were found to have been hospitalized for medical and mental health reasons, more often than non-autistic youth. Autistic youth were also more likely to have attended specialist appointments and to have been given medication. These differences were particularly large for medications commonly used for mental health conditions (e.g. anxiety, depression, attention deficit hyperactivity disorder) or associated symptoms. Autistic youth who also had an intellectual disability were more likely to use healthcare services for physical health conditions, but were less likely to use mental health services, when compared with autistic youth who did not have an intellectual disability. These findings, along with other research, suggest that the healthcare needs of autistic youth are not always being met. Further work is needed to enhance our understanding of co-occurring conditions among autistic youth, including those that result in high rates of health service use, in order to inform the development of healthcare services and training for healthcare professionals to better cater to the needs of autistic youth.

Bibliographie citée par cette référence

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Vue d’ensemble de l’inclusion dans la bibliographie

Ces indicateurs décrivent la bibliographie citée importée pour cette publication. Les métriques de références citées utilisent le total des références citées comme dénominateur. Les métriques d’auteurices cité·es indiquent si elles utilisent toutes les occurrences d’auteurices cité·es ou seulement les occurrences rattachées à des auteurices déjà intégré·es à la base de données AutiHub. Ils utilisent les rattachements mis en cache entre les auteurices cité·es et les auteurices intégré·es à la base de données AutiHub. Dernier calcul : 16/08/2026 11:30.

Références citées
70
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
1 / 70 (1,4 %)
Occurrences d’auteur·ices cité·es identifié·es comme autistes
3 / 448 (0,7 %)
Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 3 / 91 (3,3 %). Auteurices cité·es distinct·es identifié·es comme autistes : 3 / 395 (0,8 %).
Occurrences citées rattachées à la base AutiHub
91 / 448 (20,3 %)
Auteurices cité·es distinct·es rattaché·es : 60 / 395 (15,2 %)
Occurrences rattachées, non identifiées comme autistes
88 / 91 (96,7 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 88 / 448 (19,6 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 57 / 60 (95,0 %).
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