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新诊断成年 ADHD 相关精神和躯体共病的医疗利用和成本。

Healthcare utilization and costs of psychiatric and somatic comorbidities associated with newly diagnosed adult ADHD.

机构信息

School of Medical Sciences, Örebro University, Örebro, Sweden.

Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.

出版信息

Acta Psychiatr Scand. 2021 Jul;144(1):50-59. doi: 10.1111/acps.13297. Epub 2021 May 4.

Abstract

BACKGROUND

Psychiatric and somatic problems in young adulthood have been found to be main drivers of costs in individuals with childhood ADHD. However, knowledge of the patterns of healthcare utilization and costs of comorbidities in middle-aged adults with newly diagnosed ADHD is very limited.

METHOD

We studied individuals born 1966-1978 (from the Swedish Total Population Register) with newly diagnosed ADHD between the ages of 30-45 years and individuals without ADHD matched on birthdate, birth county, and sex. Healthcare utilization and expenditure for psychiatric and somatic disorders were obtained over four years (two years pre- and post-initial ADHD diagnosis).

RESULTS

Middle-aged adults with newly diagnosed ADHD showed higher levels of healthcare utilization and costs (outpatient, inpatient, medications) for psychiatric and somatic comorbidities relative to adults without ADHD, both before and after the initial diagnosis. Females showed greater average group differences across the study period for medication prescriptions than males. Total incremental annual costs per capita were €2478.76 in adults with ADHD relative to those without, and costs were mainly driven by inpatient care. Psychiatric outpatient visits were statistically significantly higher the year before the ADHD diagnosis compared with two years before and after the diagnosis.

CONCLUSION

This study demonstrates the substantial burden of psychiatric and somatic comorbidities in middle-aged adults newly diagnosed with ADHD. Psychiatric outpatient visits peaked in the year leading up to the ADHD diagnosis. Findings further suggested that females with ADHD may seek more treatment for comorbidities than males, which may reflect a general female tendency.

摘要

背景

在儿童时期患有 ADHD 的人群中,成年后的精神和躯体问题被认为是导致个人医疗费用的主要原因。然而,对于中年新诊断 ADHD 患者共病的医疗保健利用和费用模式的了解非常有限。

方法

我们研究了 1966 年至 1978 年出生的个体(来自瑞典总人口登记处),这些个体在 30-45 岁之间被新诊断为 ADHD,与出生日期、出生县和性别相匹配的无 ADHD 个体。在四年内(在 ADHD 初始诊断前两年和后两年)获得了精神和躯体障碍的医疗保健利用和支出数据。

结果

与无 ADHD 的成年人相比,新诊断为 ADHD 的中年成年人在精神和躯体共病方面表现出更高水平的医疗保健利用和费用(门诊、住院、药物),无论是在初始诊断之前还是之后。女性在整个研究期间的药物处方平均组间差异大于男性。相对于无 ADHD 的成年人,患有 ADHD 的成年人的人均年度增量成本为 2478.76 欧元,费用主要由住院治疗驱动。与 ADHD 诊断前两年相比,ADHD 诊断前一年的精神科门诊就诊次数明显更高。

结论

这项研究表明,中年新诊断 ADHD 患者的精神和躯体共病负担很大。精神科门诊就诊量在 ADHD 诊断前一年达到高峰。研究结果进一步表明,患有 ADHD 的女性可能比男性寻求更多的共病治疗,这可能反映了女性的一般倾向。

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