Last-Resort Behavioral Health Care Utilization in Individuals with Spina Bifida.

Abstract

To examine the differences in last-resort behavioral care (LRBH) utilization for mental health and substance use between individuals with spina bifida (SB) and matched non-SB controls. We analyzed data from the California Department of Health Care Access and Information (2005-2017) to compare inpatient and ED behavioral health utilization between individuals with SB and non-SB controls (1:5 ratio). Multivariable logistic regression was used to assess the likelihood of LRBH use, adjusting for demographic, socioeconomic, and clinical variables. Emergency room and inpatient hospitalizations across all practice types in California. We queried the California Department of Health Care Access and Information (HCAI) database from 2005 - 2017. We created a cohort by frequency-matching those with SB 1:5 by birth year and facility (inpatient or ED) to a randomly generated control sample without SB. -Main Outcome Measure: Encounters per patient with a primary behavioral health diagnosis. The cohort included 19,394 individuals with SB and 96,970 controls. Individuals with SB had a higher mean Charlson Comorbidity Index (CCI) (2.0 vs. 1.1) and more LRBH encounters (5.1 vs. 2.7 per patient). SB was independently associated with increased risk of ≥1 encounter (aOR 1.49; 95% CI: 1.42-1.56). Within the SB group, increased CCI (aOR 1.04), female sex (aOR 1.12), and non-private insurance (aOR 2.48) predicted higher utilization. Asian/Pacific Islander race (aOR 0.32), Hispanic ethnicity (aOR 0.41), and those residing in lower socioeconomic advantage areas (aOR 0.92) were associated with decreased odds of behavioral health care encounters. Individuals with SB are at significantly higher risk for LRBH utilization compared to non-SB controls. SB independently predicted nearly 50% increased odds of requiring such services. Our analysis identifies significant sociodemographic predictors of LRBH care within the SB population, which should be further explored as potential targets for preventive behavioral health intervention.