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Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder

JAMA 285:60-66.

Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

CONTEXT: A shortage of data exists on medical care use by persons with attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE: To compare medical care use and costs among persons with and without ADHD.

DESIGN AND SETTING: Population-based cohort study conducted in Rochester, Minn.

SUBJECTS: All children born in 1976-1982 were followed up through 1995, using school and medical records to identify those with ADHD. The 4880 birth cohort members (mean age, 7. 3 years) still residing in Rochester in 1987 were followed up in medical facility-linked billing databases until death, emigration, or December 31, 1995.

MAIN OUTCOME MEASURES: Clinical diagnoses, likelihood and frequency of inpatient and outpatient hospitalizations, emergency department (ED) visits, and total medical costs (including ambulatory care), compared among individuals with and without ADHD.

RESULTS: Among the 4119 birth cohort members who remained in the area through 1995 (mean age, 15.3 years), 7.5% (n = 309) had met criteria for ADHD. Compared with persons without ADHD, those with ADHD were more likely to have diagnoses in multiple categories, including major injuries (59% vs 49%; P.001) and asthma (22% vs 13%; P.001). The proportion with anyhospital inpatient, hospital outpatient, or ED admission was higher for persons with ADHD vs those without ADHD (26% vs 18% [P. 001], 41% vs 33% [P =.006], and 81% vs 74% [P =.005], respectively). The 9-year median costs for persons wth ADHD compared with those without ADHD were mre than double ($4306 vs $1944; P.001), even for the subset with no hospital or ED admissions (eg, median 1987 costs, $128 vs $65; P.001). The differences between individuals with and without ADHD were similar for males and females across all age groups.

CONCLUSION: In our cohort, compared with persons without ADHD, those with ADHD exhibited substantially greater use of medical care in multiple care delivery settings.

PMID: 11150110