Zaleski Amanda L, Craig Kelly J Thomas, Khan Raiha, Waber Rebecca, Xin Wei, Powers Makia, Ramey Una, Verbrugge Dorothea J, Fernandez-Turner Deborah
Clinical Evidence Development, CVS Health ®, Wellesley, MA, USA.
Clinical Evidence Development Aetna ® Medical Affairs, CVS Health ®, 151 Farmington Avenue, 06156, Hartford, CT, USA.
BMC Health Serv Res. 2025 Aug 9;25(1):1048. doi: 10.1186/s12913-025-13296-2.
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are among the most common neurodevelopmental disorders. However, significant gaps persist in understanding health and healthcare-related needs of individuals diagnosed with ASD and/or ADHD across the lifespan. Thus, this real-world evaluation sought to characterize the prevalence of ASD, ADHD, and co-existing ASD and ADHD (AuDHD); sociodemographics; frequent comorbidities and co-occurring diagnoses; and healthcare utilization and expenditures among members of a large national payor.
This study represents an observational, cross-sectional evaluation of claims from a large national payor. Retrospective claims analyses of commercial fully insured (C-FI) members from 1/1/2022-12/31/2022 identified diagnoses for ASD and/or ADHD among adults (≥ 18 year) and children (< 18 year). Chi-squared tests, T-tests, and Fisher's exact tests examined between-group differences in sociodemographic, health, and healthcare-related measures among members with neurodevelopmental disorders compared to members without ASD and/or ADHD.
Within adults (N = 1,928,106), 4.2% of members (60.2% White, 52.9% female, mean age: 34.1 ± 10.9 year) were diagnosed with neurodevelopmental disorders: ADHD (4.0%, n = 76,515); ASD (0.1%, n = 2,134); or AuDHD (0.1%, n = 1,266) (all P < 0.0001). Within children (N = 464,749), 6.7% of members (47.8% White, 67.5% male, mean age: 11.3 ± 3.8 year) were diagnosed with neurodevelopmental disorders: ADHD (5.0%, n = 23,250); ASD (1.1%, n = 5,098); or AuDHD (0.6%, n = 2,665) (all P < 0.0001). Increased odds (i.e., ≥ 2) for certain co-occurring diagnoses were consistently observed across all three neurodevelopmental cohorts for adults and children, which were primarily behavioral health (BH)-related. Compared to those without neurodevelopmental disorders, both adults and children with ASD and/or ADHD had higher healthcare utilization rates [adults: 615.2 to 1024.8 per thousand per month (PTPM); children: 398.4 to 1205.3 PTPM; all P < 0.001)]; largely owing to increased use of BH-related services, translating to greater total healthcare expenditures [adults: $140.3 to $292.1 per member per month (PMPM); children: $50.8 to $845.4 PMPM; all P < 0.001)].
Leveraging real-world data of 2,392,855 members from a large national payor, 4.1% of adults and 6.7% of children were diagnosed with ASD and/or ADHD. This population appeared to consistently exhibit specific co-existing diagnoses that frequently co-occur in addition to greater observed healthcare utilization and expenditures. Trial registration Not applicable.
自闭症谱系障碍（ASD）和注意力缺陷多动障碍（ADHD）是最常见的神经发育障碍。然而，在了解患有ASD和/或ADHD的个体在其一生中的健康及与医疗保健相关的需求方面，仍存在重大差距。因此，这项真实世界评估旨在描述ASD、ADHD以及ASD与ADHD共病（AuDHD）的患病率；社会人口统计学特征；常见共病和并发诊断；以及一家大型全国性医保机构成员的医疗保健利用情况和支出。
本研究是对一家大型全国性医保机构索赔数据的观察性横断面评估。对2022年1月1日至2022年12月31日商业全额保险（C-FI）成员的索赔数据进行回顾性分析，以确定成人（≥18岁）和儿童（<18岁）中的ASD和/或ADHD诊断。卡方检验、T检验和Fisher精确检验用于检验神经发育障碍成员与无ASD和/或ADHD成员在社会人口统计学、健康及与医疗保健相关指标上的组间差异。
在成人（N = 1,928,106）中，4.2%的成员（60.2%为白人，52.9%为女性，平均年龄：34.1±10.9岁）被诊断患有神经发育障碍：ADHD（4.0%，n = 76,515）；ASD（0.1%，n = 2,134）；或AuDHD（0.1%，n = 1,266）（所有P<0.0001）。在儿童（N = 464,749）中，6.7%的成员（47.8%为白人，67.5%为男性，平均年龄：11.3±3.8岁）被诊断患有神经发育障碍：ADHD（5.0%，n = 23,250）；ASD（1.1%，n = 5,098）；或AuDHD（0.6%，n = 2,665）（所有P<0.0001）。在所有三个成人和儿童神经发育队列中，均一致观察到某些并发诊断的几率增加（即≥2），这些诊断主要与行为健康（BH）相关。与无神经发育障碍的人相比，患有ASD和/或ADHD的成人和儿童的医疗保健利用率更高[成人：每月每千人615.2至1024.8次（PTPM）；儿童：398.4至1205.3 PTPM；所有P<0.001]；这主要是由于BH相关服务的使用增加，导致医疗保健总支出更高[成人：每月每位成员140.3至292.1美元（PMPM）；儿童：50.8至845.4 PMPM；所有P<0.001]。
利用一家大型全国性医保机构2,392,855名成员的真实世界数据，4.1%的成人和6.7%的儿童被诊断患有ASD和/或ADHD。该人群似乎始终表现出特定的共存诊断，除了观察到的更高的医疗保健利用率和支出外，这些诊断还经常同时出现。试验注册不适用。
