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Use of healthcare services before diagnosis of attention-deficit/hyperactivity disorder: a population-based matched
Vibhore Prasad1,2,3, Emma Rezel-Potts4, Patrick White4
1Population Health Science, King's College London, London, UK vibhore.prasad@kcl.ac.uk.
Insights
Children and young people with attention-deficit/hyperactivity disorder (ADHD) used healthcare services twice as often as controls. Early healthcare contacts for physical conditions may help identify ADHD sooner.
Area of Science:
- Pediatric Healthcare Utilization
- Attention-Deficit/Hyperactivity Disorder (ADHD) Research
- Public Health
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder impacting children and young people (CYP).
- Understanding healthcare service utilization patterns in CYP with ADHD is crucial for timely diagnosis and management.
- Previous research has indicated potential differences in healthcare access and needs between CYP with and without ADHD.
Purpose of the Study:
- To compare healthcare service utilization and reasons for attendance among CYP with ADHD versus matched non-ADHD controls.
- To identify specific patterns of healthcare use preceding an ADHD diagnosis.
- To explore the potential for early identification of ADHD through routine healthcare encounters.
Main Methods:
- A population-based matched case-control study utilizing English primary care electronic health records linked to hospital records (Clinical Practice Research Datalink, 1998-2015).
- Included 8127 CYP aged 4-17 years with an ADHD diagnosis and 40,136 matched non-ADHD controls.
- Analyzed medical diagnoses, prescriptions, and hospital admissions/procedures in the two years prior to diagnosis or index date.
Main Results:
- CYP with ADHD utilized healthcare services approximately twice as often as controls (GP rate ratio: 2.0; hospital rate ratio: 1.8).
- Strongest association for GP attendances in CYP with ADHD was for 'mental and behavioural disorders' (OR=25.2).
- Increased GP attendance rates were also observed for conditions like eye, ear, nose, throat, oral issues (OR=1.5), asthma (OR=1.3), and eczema (OR=1.2).
Conclusions:
- CYP with ADHD exhibit significantly higher healthcare service utilization in the two years preceding diagnosis compared to their non-ADHD peers.
- ADHD is associated with increased rates of both mental/behavioral disorders and certain physical conditions, including asthma and eczema.
- Routine healthcare encounters, particularly for physical ailments, may serve as valuable opportunities for earlier recognition and diagnosis of ADHD in children and young people.
Objective:
To compare use of healthcare services and reasons for attendance by children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) versus non-ADHD controls.
Design:
Population-based matched case-control study.
Setting:
English primary care electronic health records with linked hospital records from the Clinical Practice Research Datalink, 1998-2015.
Participants:
8127 CYP with an ADHD diagnosis aged 4-17 years at the time of diagnosis and 40 136 non-ADHD controls matched by age, sex and general practitioner (GP) practice.
Main Outcome Measures:
Medical diagnoses, prescriptions, hospital admissions and hospital procedures in the 2 years before diagnosis (or the index date for controls).
Results:
CYP with ADHD attended healthcare services twice as often as controls (rate ratios: GP: 2.0, 95% CI=2.0, 2.1; hospital 1.8, 95% CI=1.8, 1.9). CYP with ADHD attended their GP, received prescriptions and were admitted to hospital for a wide range of reasons. The strongest association for GP attendances, comparing CYP with versus without ADHD, was for 'mental and behavioural disorders' (OR=25.2, 95% CI=23.3, 27.2). Common reasons for GP attendance included eye, ear, nose, throat, oral (OR=1.5, 95% CI=1.4, 1.5) and conditions such as asthma (OR=1.3, 95% CI=1.3, 1.4) or eczema (OR=1.2, 95% CI=1.0, 1.3).
Conclusions:
Two years before diagnosis, CYP with ADHD attended healthcare services twice as often as CYP without. CYP with ADHD had increased rates of physical conditions, such as asthma and eczema. These contacts may be an opportunity for earlier recognition and diagnosis of ADHD.
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