Associations of Co-occurring Symptom Trajectories With Sex, Race, Ethnicity, and Health Care Utilization in Children

Key Points

Question

Are co-occurring pain, psychological, and sleep disturbance symptom trajectories associated with demographic characteristics of children and are symptom trajectories associated with nonroutine health care utilization during early adolescence?

Findings

This cohort study, including 11 473 children, used 9 symptom trajectories to classify participants in the Adolescent Brain Cognitive Development (ABCD) study cohort, most of whom clustered with asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children had moderate to high co-occurring symptom trajectories, but less than half of these reported nonroutine medical or mental health care use, with lower rates among Black, other race, and Hispanic children.

Meaning

These findings suggest that there is a need for better recognition and equitable, prompt interventions to mitigate symptom persistence among children.

Abstract

This cohort study assesses co-occurring pain, psychological, and sleep disturbance symptom trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization

Abstract

Importance

Co-occurring physical and psychological symptoms during childhood and early adolescence may increase risk of symptom persistence into adulthood.

Objective

To describe co-occurring pain, psychological, and sleep disturbance symptom (pain-PSS) trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization.

Design, Setting, and Participants

This cohort study was a secondary analysis of longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study, collected between 2016 and 2022 at 21 research sites across the US. Participants included children with 2 to 4 complete annual symptom assessments. Data were analyzed from November 2022 to March 2023.

Main Outcomes and Measures

Four-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain-PSS scores, including depression and anxiety, were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Nonroutine medical care and mental health care utilization were measured using medical history and Diagnostic and Statistical Manual of Mental Disorders ( Fifth Edition) items.

Results

A total of 11 473 children (6018 [52.5%] male; mean [SD] age at baseline, 9.91 [0.63] years) were included in analyses. Four no pain-PSS and 5 pain-PSS trajectories were supported with good or excellent model fit (predicted probabilities, 0.87-0.96). Most children (9327 [81.3%]) had asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children (2146 [18.7%]) had moderate to high co-occurring symptom trajectories that persisted or worsened. Compared with White children, there was a lower relative risk of having moderate to high co-occurring symptom trajectories among Black children (adjusted relative risk ratio [aRRR] range, 0.15-0.38), Hispanic children (aRRR range, 0.58-0.67), and children who identified as another race (including American Indian, Asian, Native Hawaiian, and other Pacific Islader; aRRR range, 0.43-0.59). Less than half of children with moderate to high co-occurring symptom trajectories used nonroutine health care, despite higher utilization compared with asymptomatic children (nonroutine medical care: adjusted odds ratio [aOR], 2.43 [95% CI, 1.97-2.99]; mental health services: aOR, 26.84 [95% CI, 17.89-40.29]). Black children were less likely to report nonroutine medical care (aOR, 0.61 [95% CI, 0.52-0.71]) or mental health care (aOR, 0.68 [95% CI, 0.54-0.87]) than White children, while Hispanic children were less likely to have used mental health care (aOR, 0.59 [95% CI, 0.47-0.73]) than non-Hispanic children. Lower household income was associated with lower odds of nonroutine medical care (aOR, 0.87 [95% CI, 0.77-0.99]) but not mental health care.

Conclusions and Relevance

These findings suggest there is a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.