美国住院儿科患者注意缺陷多动障碍的经济负担和共病情况。
Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States.
机构信息
RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709 USA.
出版信息
Child Adolesc Psychiatry Ment Health. 2010 Dec 14;4:31. doi: 10.1186/1753-2000-4-31.
BACKGROUND
This retrospective database analysis used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) to examine common primary diagnoses among children and adolescents hospitalized with a secondary diagnosis of attention- deficit/hyperactivity disorder (ADHD) and assessed the burden of ADHD.
METHODS
Hospitalized children (aged 6-11 years) and adolescents (aged 12-17 years) with a secondary diagnosis of ADHD were identified. The 10 most common primary diagnoses (using the first 3 digits of the ICD-9-CM code) were reported for each age group. Patients with 1 of these conditions were selected to analyze demographics, length of stay (LOS), and costs. Control patients were selected if they had 1 of the 10 primary diagnoses and no secondary ADHD diagnosis. Patient and hospital characteristics were reported by cohort (i.e., patients with ADHD vs. controls), and LOS and costs were reported by primary diagnosis. Multivariable linear regression analyses were undertaken to adjust LOS and costs based on patient and hospital characteristics.
RESULTS
A total of 126,056 children and 204,176 adolescents were identified as having a secondary diagnosis of ADHD. Among children and adolescents with ADHD, the most common diagnoses tended to be mental health related (i.e., affective psychoses, emotional disturbances, conduct disturbances, depressive disorder, or adjustment reaction). Other common diagnoses included general symptoms, asthma (in children only), and acute appendicitis. Among patients with ADHD, a higher percentage were male, white, and covered by Medicaid. LOS and costs were higher among children with ADHD and a primary diagnosis of affective psychoses (by 0.61 days and $51), adjustment reaction (by 1.71 days and $940), or depressive disorder (by 0.41 days and $124) versus controls. LOS and costs were higher among adolescents with ADHD and a primary diagnosis of affective psychoses (by 1.04 days and $352), depressive disorder (by 0.94 days and $517), conduct disturbances (by 0.86 days and $1,330), emotional disturbances (by 1.45 days and $1,626), adjustment reaction (by 1.25 days and $702), and neurotic disorders (by 1.60 days and $541) versus controls.
CONCLUSION
Clinicians and health care decision makers should be aware of the potential impact of ADHD on hospitalized children and adolescents.
背景
本回顾性数据库分析使用了医疗保健成本和利用项目的全国住院患者样本（NIS）的数据，以检查因注意力缺陷/多动障碍（ADHD）而住院的儿童和青少年的常见次要诊断，并评估 ADHD 的负担。
方法
确定了患有次要诊断为 ADHD 的住院儿童（6-11 岁）和青少年（12-17 岁）。报告了每个年龄组中最常见的 10 种主要诊断（使用 ICD-9-CM 代码的前 3 位数字）。选择具有这些病症之一的患者来分析人口统计学，住院时间（LOS）和费用。如果患者具有 10 种主要诊断之一且没有 ADHD 的次要诊断，则选择对照患者。按队列报告患者和医院特征（即，ADHD 患者与对照患者），并按主要诊断报告 LOS 和费用。进行多变量线性回归分析，以根据患者和医院特征调整 LOS 和费用。
结果
共确定了 126,056 名儿童和 204,176 名青少年患有 ADHD 的次要诊断。在患有 ADHD 的儿童和青少年中，最常见的诊断往往与心理健康有关（即情感精神病，情绪障碍，行为障碍，抑郁障碍或适应反应）。其他常见诊断包括一般症状，哮喘（仅在儿童中）和急性阑尾炎。在 ADHD 患者中，男性，白人，并且由医疗补助计划承保的比例较高。患有 ADHD 且主要诊断为情感精神病（相差 0.61 天和 51 美元），适应反应（相差 1.71 天和 940 美元）或抑郁障碍（相差 0.41 天和 124 美元）的儿童的 LOS 和费用更高与对照相比。患有 ADHD 且主要诊断为情感精神病（相差 1.04 天和 352 美元），抑郁障碍（相差 0.94 天和 517 美元），行为障碍（相差 0.86 天和 1330 美元），情绪障碍（相差 1.45 天和 1626 美元），适应反应（相差 1.25 天和 702 美元）和神经症（相差 1.60 天和 541 美元）的青少年的 LOS 和费用更高与对照相比。
结论
临床医生和医疗保健决策者应意识到 ADHD 对住院儿童和青少年的潜在影响。
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