Health Care Utilization and Cancer Screening Among Patients with Neurodivergence in a Safety-Net Adult Primary Care Clinic.

Abstract

Most research among adults with autism spectrum disorder (ASD) has been conducted in a White, English-speaking, and commercially insured population. However, patterns of care may differ in a more diverse safety-net setting. To assess health care utilization and cancer screening among patients with diagnosed ASD or another similar neurodivergent diagnosis as compared with the general clinic population in a safety-net adult primary care population. Retrospective cohort PATIENTS: Adults ≥ 18 with at least one primary care visit between 1/1/2021 and 5/10/2024. ASD and neurodivergent diagnoses were identified using ICD-10 codes. Outpatient visit completion and no-show rates; emergency department (ED) use and hospitalization; odds of cervical, breast, and colon cancer screening. Among 69,344 patients, 381 had a neurodivergent diagnosis (135 ASD and 246 other neurodivergent diagnoses). Compared to the general population, the neurodivergent group was younger (mean age 37.5 vs. 46.2) and more often male (55.9% vs. 42.9%) and had a higher median Elixhauser comorbidity index (1.0 vs. 0). Both groups had similar proportions of those on Medicaid (46.2% vs. 40.5%) and racial and ethnic diversity (19.9% vs. 19.5% identifying as White). In adjusted analyses, patients with neurodivergence had higher rates of ED visits (IRR 1.72, 95% CI 1.62-1.84) and hospitalizations (IRR 2.04, 95% CI 1.84-2.28) and lower odds of cervical cancer screening (OR 0.44, 95% CI 0.31-0.64). No significant differences were observed in colon cancer screening though the qualifying population was small; mammogram completion was too low for multivariate analysis. In a diverse safety-net setting, adult patients with neurodivergence are less likely to receive cervical cancer screening and more likely to use the ED and be hospitalized than the general population. These disparities underscore the need for targeted interventions to improve care for socially complex patients with ASD and other neurodivergent diagnoses.