Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA.
Department of Statistical Science, Duke University, Durham, NC, USA.
Sci Rep. 2020 Oct 19;10(1):17677. doi: 10.1038/s41598-020-74458-2.
Children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) have 2-3 times increased healthcare utilization and annual costs once diagnosed, but little is known about their utilization patterns early in life. Quantifying their early health system utilization could uncover condition-specific health trajectories to facilitate earlier detection and intervention. Patients born 10/1/2006-10/1/2016 with ≥ 2 well-child visits within the Duke University Health System before age 1 were grouped as ASD, ADHD, ASD + ADHD, or No Diagnosis using retrospective billing codes. An additional comparison group was defined by later upper respiratory infection diagnosis. Adjusted odds ratios (AOR) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression models. Length of hospital encounters were compared between groups via Mann-Whitney U test. In total, 29,929 patients met study criteria (ASD N = 343; ADHD N = 1175; ASD + ADHD N = 140). ASD was associated with increased procedures (AOR = 1.5, p < 0.001), including intubation and ventilation (AOR = 2.4, p < 0.001); and outpatient specialty care, including physical therapy (AOR = 3.5, p < 0.001) and ophthalmology (AOR = 3.1, p < 0.001). ADHD was associated with increased procedures (AOR = 1.41, p < 0.001), including blood transfusion (AOR = 4.7, p < 0.001); hospital admission (AOR = 1.60, p < 0.001); and ED visits (AOR = 1.58, p < 0.001). Median length of stay was increased after birth in ASD (+ 6.5 h, p < 0.001) and ADHD (+ 3.8 h, p < 0.001), and after non-birth admission in ADHD (+ 1.1 d, p < 0.001) and ASD + ADHD (+ 2.4 d, p = 0.003). Each condition was associated with increased health system utilization and distinctive patterns of utilization before age 1. Recognizing these patterns may contribute to earlier detection and intervention.
患有自闭症谱系障碍 (ASD) 或注意力缺陷多动障碍 (ADHD) 的儿童一旦确诊，其医疗保健利用率和年费用就会增加 2-3 倍，但人们对他们在生命早期的利用模式知之甚少。量化他们早期的卫生系统利用情况可以揭示特定于疾病的健康轨迹，从而促进早期发现和干预。使用回顾性计费代码，将在杜克大学卫生系统中在 1 岁之前至少进行了 2 次常规儿童就诊的 2006 年 10 月 1 日至 2016 年 10 月 1 日出生的患者分为 ASD、ADHD、ASD+ADHD 或无诊断组。通过 logistic 回归模型比较组间医院就诊、程序、急诊就诊和门诊就诊的调整后比值比 (AOR)。通过 Mann-Whitney U 检验比较组间住院时间的差异。共有 29929 名患者符合研究标准（ASD N=343；ADHD N=1175；ASD+ADHD N=140）。ASD 与更多的程序相关（AOR=1.5，p<0.001），包括插管和通气（AOR=2.4，p<0.001）；以及门诊专科护理，包括物理治疗（AOR=3.5，p<0.001）和眼科（AOR=3.1，p<0.001）。ADHD 与更多的程序相关（AOR=1.41，p<0.001），包括输血（AOR=4.7，p<0.001）；住院（AOR=1.60，p<0.001）；以及 ED 就诊（AOR=1.58，p<0.001）。ASD（+6.5 小时，p<0.001）和 ADHD（+3.8 小时，p<0.001）出生后和 ADHD（+1.1 天，p<0.001）和 ASD+ADHD（+2.4 天，p=0.003）非出生后住院时间延长。每种情况都与 1 岁前的医疗保健利用率增加和独特的利用模式相关。认识到这些模式可能有助于早期发现和干预。
