Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder

Context  A shortage of data exists on medical care use by persons with attention-deficit/hyperactivity disorder (ADHD). Objective  To compare medical care use and costs among persons with and without ADHD. Design and Setting  Population-based cohort study conducted in Rochester, Minn. Subjects  All children born in 1976-1982 were followed up through 1995, using school and medical records to identify those with ADHD. The 4880 birth cohort members (mean age, 7.3 years) still residing in Rochester in 1987 were followed up in medical facility–linked billing databases until death, emigration, or December 31, 1995. Main Outcome Measures  Clinical diagnoses, likelihood and frequency of inpatient and outpatient hospitalizations, emergency department (ED) visits, and total medical costs (including ambulatory care), compared among individuals with and without ADHD. Results  Among the 4119 birth cohort members who remained in the area through 1995 (mean age, 15.3 years), 7.5% (n = 309) had met criteria for ADHD. Compared with persons without ADHD, those with ADHD were more likely to have diagnoses in multiple categories, including major injuries (59% vs 49%; P<.001) and asthma (22% vs 13%; P<.001). The proportion with any hospital inpatient, hospital outpatient, or ED admission was higher for persons with ADHD vs those without ADHD (26% vs 18% P<.001], 41% vs 33% P = .006], and 81% vs 74% P = .005], respectively). The 9-year median costs for persons with ADHD compared with those without ADHD were more than double ($4306 vs $1944; P<.001), even for the subset with no hospital or ED admissions (eg, median 1987 costs, $128 vs $65; P<.001). The differences between individuals with and without ADHD were similar for males and females and across all age groups. Conclusion  In our cohort, compared with persons without ADHD, those with ADHD exhibited substantially greater use of medical care in multiple care delivery settings.