Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Objective: Half of the population with mental retardation is estimated to have Medicaid health insurance coverage and this program is estimated to pay almost a third of youth injury care costs in the U.S. Starting with this information, a determination of injury prevalence among a large sample of youth with mental retardation was sought to confirm existing findings about higher injury risk in this population. This study also drew on an important new resource for injury surveillance in application to youth with mental retardation. Design: Using data derived from eligibility and claims data collected by the Centers for Medicare and Medicaid Services' Medicaid Statistical Information System for calendar year 1999, injury prevalence for 8.4 million Medicaid-eligible youth in 26 states was measured through the use of an episode algorithm for the identification of injury using ICD-9-CM and CPT diagnostic codes. Data from inpatient, outpatient and long-term care settings were examined in order to provide a broad picture of injury prevalence than is allowed by single-site-of-care studies. Logistic regression analyses were conducted to assess injury risk for Medicaid beneficiaries aged one through twenty with a diagnosis of mental retardation. A comparison group comprised of youth without mental retardation in the same age group was also studied. Findings: In total, 36.9 percent (N=18,344) of youth with mental retardation had at least one injury claim as compared with 23.5 percent (N=1,978,501) among those without mental retardation. Overall, males were more likely than females to experience injury in this population, a finding that differed from existing research results. Controlling for age and gender, youth with mental retardation were more likely to be treated for all types of injuries (OR: 1.74), and were especially likely to be treated for poisoning (OR: 3.72), foreign body injuries (OR: 3.45), dislocations (OR: 2.74) and internal injuries (OR: 2.49). Conclusions: Youth with mental retardation, especially males, are at higher risk for injury than are their counterparts without mental retardation. Although most types of injury were prevalent at a greater rate in this population, four types of injuries may be especially important to target for prevention intervention, poisoning, foreign body injuries, dislocations and internal injuries. Policy and Practice implications: The higher risk of injury shown among this sample of youth with mental retardation may result in increased disability and morbidity for this population. This has implications for community inclusion, a central policy and practice goal for youth with mental retardation in school and community settings. Youth injuries in this population can also result in significant costs for public insurance programs in the United States and given that a majority of youth with mental retardation are covered by the Medicaid health insurance program and are involved in Medicaid-funded community programs, targeted prevention interventions must be formulated and implemented by social work administrators, policymakers and direct practitioners in order to support this vulnerable population and increase cost savings. Planning for prevention interventions can be explored further by focusing in on the specific injury types for which this population is at greatest risk.