Racial/ethnic differences in hospital use and cost among a statewide population of children with Down syndrome.
Black and Hispanic children with Down syndrome spend more days and dollars in the hospital while using fewer outpatient therapy services.
01Research in Context
What this study did
Derrington et al. (2013) looked at every child born with Down syndrome in Massachusetts. They counted how many times each child went back to the hospital and what it cost. Then they split the kids by race and ethnicity to see if the numbers differed.
What they found
Hispanic and Black children returned to the hospital more often than White children. Their hospital bills were also higher. Most extra visits were for breathing and heart problems.
How this fits with other research
Byiers et al. (2025) asked the opposite question and got a mirror-image answer. Using Medicaid data they found Black children with Down syndrome use less therapy and spend less Medicaid money. Hospital bills went up; therapy bills went down.
Gandhi et al. (2022) in Wales showed that all infants with Down syndrome land in the hospital early and often. Their study did not sort by race, so Mae et al. adds the equity lens to the same picture.
Parish et al. (2012) saw Latino children with autism and other delays get worse health-care access when providers lacked cultural rapport. The pattern fits: kids of color with developmental disabilities receive fewer outpatient services and more crisis hospital care.
Why it matters
You can build two checks into your service plan. First, schedule extra parent training on breathing and heart signs before they become ER trips. Second, if the family is Hispanic or Black, add a care-coordination goal that tracks hospital days. One page in the behavior plan that lists the pediatric cardiologist and pulmonologist numbers can cut missed appointments and later admissions.
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02At a glance
03Original abstract
Children with Down syndrome (DS) use hospital services more often than children without DS, but data on racial/ethnic variations are limited. This study generated population-based estimates of hospital use and cost to 3 years of age by race/ethnicity among children with DS in Massachusetts using birth certificates linked to birth defects registry and hospital discharge data from 1999 to 2004. Hospital use (≥ 1 post-birth hospitalization and median days hospitalized birth and post-birth) and reasons for hospitalization were compared across maternal race/ethnicity using relative risk (RR) and Wilcoxon rank sums tests, as appropriate. Costs were calculated in 2011 United States dollars. Greater hospital use was observed among children with DS with Hispanic vs. Non-Hispanic White (NHW) mothers (post-birth hospitalization: RR 1.4; median days hospitalized: 20.0 vs. 11.0, respectively). Children with DS and congenital heart defects of Non-Hispanic Black (NHB) mothers had significantly greater median days hospitalized than their NHW counterparts (24.0 vs. 16.0, respectively). Respiratory diagnoses were listed more often among children with Hispanic vs. NHW mothers (50.0% vs. 29.1%, respectively), and NHBs had more cardiac diagnoses (34.1% vs. 21.5%, respectively). The mean total hospital cost was nine times higher among children with DS ($40,075) than among children without DS ($4053), and total costs attributable to DS were almost $18 million. Median costs were $22,781 for Hispanics, $18,495 for NHBs, and $13,947 for NHWs. Public health interventions should address the higher rates of hospital use and hospitalizations for respiratory and cardiac diseases among racial/ethnic minority children with DS in Massachusetts.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.06.022