Lijing Ouyang

Attention-Deficit/Hyperactivity Disorder Symptoms and Child Maltreatment: A Population-Based Study

OBJECTIVE To examine whether symptoms of attention-deficit/hyperactivity disorder (ADHD) during childhood are associated with child maltreatment. STUDY DESIGN The study sample consisted of 14 322 participants in the National Longitudinal Study of Adolescent Health. We used logistic regression and propensity score matching to examine the relationship, adjusting for demographic, socioeconomic, and familial risk factors for child maltreatment. RESULTS Inattentive type, by criteria of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, was significantly associated with the likelihood of supervision neglect (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2-2.2), physical neglect (OR: 2.1; 95% CI: 1.4-3.1), physical abuse (OR: 1.6; 95% CI: 1.1-2.3), and contact sexual abuse (OR: 2.6; 95% CI: 1.5-4.5). To a lesser extent, hyperactive type was associated with the likelihood of supervision neglect (OR: 1.5; 95% CI: 1.1-2.0) and physical abuse (OR: 1.3; 95% CI: 1.0-1.6). The association between hyperactive type and physical neglect or contact sexual abuse was not significant. The results from the propensity score matching were similar. CONCLUSIONS Childhood ADHD symptoms were associated with self-reported child maltreatment. Health care providers should be alert to the potential for child maltreatment among children with ADHD symptoms, especially those with inattentive symptoms.

Autism spectrum disorders and health care expenditures: the effects of co-occurring conditions.

Objective: Children with autism spectrum disorders (ASDs) often have co-occurring conditions, but little is known on the effect of those conditions on their medical care cost. Medical expenditures attributable to ASDs among Medicaid-enrolled children were calculated, and the effects of 3 commonly co-occurring conditions—intellectual disability (ID), attention deficit/hyperactivity disorder (ADHD), and epilepsy—on those expenditures were analyzed. Methods: Using MarketScan Medicaid Multi-State Databases (2003–2005) and the International Classification of Disease, Ninth Revision, children with ASD were identified. Children without ASD formed the comparison group. The 3 co-occurring conditions were identified among both the ASD and the comparison groups. Annual mean, median, and 95th percentile of total expenditures were calculated for children with ASD and the co-occurring conditions and compared with those of children without ASD. Multivariate analyses established the influence of each of those co-occurring conditions on the average expenditures for children with and without ASD. Results: In 2005, 47% of children with ASD had at least 1 selected co-occurring condition; attention deficit/hyperactivity disorder was the most common, at 30%. The mean medical expenditures for children with ASD were 6 times higher than those of the comparison group. Children with ASD and ID incurred expenditures 2.7 times higher than did children with ASD and no co-occurring condition. Conclusion: Medicaid-enrolled children with ASD incurred higher medical costs than did Medicaid-enrolled children without ASD. Among Medicaid-enrolled children with ASD, cost varied substantially based on the presence of another neurodevelopmental disorder. In particular, children with ID had much higher costs than did other children with ASD.

Healthcare Expenditures for Privately Insured People With Cystic Fibrosis

With improved survival and new therapies for people with cystic fibrosis (CF), updated information on medical care expenditures for those individuals is needed. We estimated medical care expenditures, including both insurance reimbursements and patient out‐of‐pocket expenses, for privately insured people with CF and investigated how those expenditures varied with certain complications of CF. From a private insurance claims database of people covered by health plans associated with large corporate employers, we identified people with CF who were currently receiving medical care for the disorder and characterized their medical expenditures during the period 2004–2006. We selected a matching group of people who did not have CF based on age, sex, and geographic area, and calculated incremental expenditures associated with CF. We also examined the effect of age and certain complications of CF on these expenditures. The annual medical care expenditure for a person with actively managed CF averaged

Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism: findings from health insurance claims data

48,098 in 2006 dollars, which was 22 times higher than for a person without CF. This ratio is high relative to other chronic disorders. Outpatient prescription medications made up the largest component of total expenditures for people with CF (39%). Those who were recorded in claims data as having a liver or lung transplant, malnutrition, diabetes, or a chronic Pseudomonas aeruginosa pulmonary infection incurred much higher expenditures than people without these conditions. People with CF will incur high medical expenditures throughout their lifespan. These findings will assist in the development of economic evaluations of future CF screening and management initiatives. Pediatr Pulmonol. 2009; 44:989–996. ©2009 Wiley‐Liss, Inc.

Health Care Utilization and Expenditures for Children and Young Adults With Muscular Dystrophy in a Privately Insured Population

BackgroundThyroid hormone treatment in children with congenital hypothyroidism can prevent intellectual disability. Guidelines recommend that children diagnosed with congenital hypothyroidism through newborn screening remain on treatment to at least 3 years of age, after which a trial off therapy can determine which children have transient hypothyroidism. The purpose of this study was to describe the rate at which children with congenital hypothyroidism in the United States discontinue thyroid hormone treatment in early childhood.MethodsRetrospective analysis of the 2002-2006 MarketScan® Commercial Claims and Encounters research databases and the 2001-2005 MarketScan Multi-State Medicaid databases. Children were classified as having congenital hypothyroidism based on billing codes and having filled a prescription for thyroid hormone treatment. Kaplan-Meier curve analysis was used to determine discontinuation rates.ResultsThere were a total of 412 Medicaid-enrolled children and 292 privately-insured children with presumed congenital hypothyroidism included in this study. The overall birth prevalence of congenital hypothyroidism across both datasets was about 1 per 2,300. By 36 months, the percentage who had discontinued thyroid replacement treatment was 38% (95% Confidence Interval: 32%-44%). Medicaid-enrolled children had a more rapid decline in the first 24 months of treatment compared to those with private insurance (P = 0.02).ConclusionsMore than one-third of children treated for congenital hypothyroidism discontinued treatment within 36 months, which is inconsistent with current guidelines. It is not known how many of these children required continued treatment or experience adverse effects from discontinuation. These findings emphasize the critical need for follow-up systems to monitor the outcome of newborn screening.

Economic Evaluation of a Neural Tube Defect Recurrence-Prevention Program

We provide estimates of medical care utilization and expenditures for children and young adults younger than age 30 with muscular dystrophies in the United States. Accurate estimates are essential for calculations of lifetime costs and for economic evaluations of screening and management strategies for muscular dystrophy. We compare the medical expenditures for persons with muscular dystrophy with others by age groups. The incremental annual expenditures of medical care for privately insured individuals with muscular dystrophy relative to others in 2004 averaged

Employment impact and financial burden for families of children with fragile X syndrome: findings from the National Fragile X Survey.

18 930 and ranged from

Hospitalization for urinary tract infections and the quality of preventive health care received by people with spina bifida

13 464 at ages 5 to 9 to

A comparison of family financial and employment impacts of fragile X syndrome, autism spectrum disorders, and intellectual disability

32 541 at ages 15 to 19. Individuals with muscular dystrophy had average medical expenditures 10 to 20 times greater than individuals without muscular dystrophy. Individuals aged 15 to 19 years had the highest number of inpatient admissions related to respiratory infections and cardiac complications. The findings underscore the need for appropriate treatment options for individuals with muscular dystrophy as they age.

Revival of the intrauterine device: increased insertions among US women with employer-sponsored insurance, 2002-2008.

BACKGROUND Women with a pregnancy affected by a neural tube defect (NTD) are encouraged to take folic acid prior to a subsequent pregnancy, but it is unknown whether organized attempts to identify and counsel such women to prevent recurrent NTDs are cost effective. METHODS Data from the South Carolina recurrence-prevention program for October 2001-September 2002 were analyzed between October 2002 and December 2003 to calculate costs. Cost-effectiveness modeling of the program during 1992-2006 was conducted during 2007. Results were calculated for three scenarios based on recurrence risk, supplement use, and the effectiveness of folic acid in preventing recurrences. For each scenario, quality-adjusted life years (QALYs) were calculated separately using prevented NTD-affected live births; prevented NTD-affected births (including fetal deaths); and all prevented NTD-affected pregnancies. RESULTS The prevention program cost approximately