Background: Children with ADHD have 2 to 3 times increased health care utilization and annual costs once diagnosed, but little is known about utilization patterns early in life, prior to diagnosis. Quantifying early health services use among children later diagnosed with ADHD could help us understand the early life impact of the disorder and uncover health care utilization patterns associated with higher ADHD risk. Methods: Electronic health record (EHR) data from the Duke University Health System (DUHS) was analyzed for patients born October 1, 2006–October 1, 2016. Those with at least two well-child visits before age 1 were grouped as ADHD or not ADHD based on retrospective billing codes. Adjusted odds ratios (AORs) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression controlling for sex, race, and ethnicity. Results: ADHD diagnoses were identified in 1,315 (4.4%) of 29,929 patients meeting criteria. Before age 1, individuals with ADHD had 60% increased odds of hospital admission, 58% increased odds of visiting the emergency department, and 41% increased odds of procedures (p < .0001), including 4.7-fold increased odds of blood transfusion (p < .0001). They also had more outpatient clinic visits (μ = 14.7 vs. μ = 12.5, p < .0001), including 52% increased odds of visiting a medical specialist, 38% increased odds of visiting a surgical specialist, 70% increased odds of visiting a neonatologist, and 71% increased odds of visiting an ophthalmologist (p < .0001 for all AORs). In addition, individuals with ADHD had 6-fold increased odds of visits related to child abuse and neglect (p = .0010). Conclusions: Children later diagnosed with ADHD were more likely to be admitted to the hospital, visit the ED, and visit specific medical and surgical services before age 1. Future work will identify patterns of health interactions unique to ADHD to stratify ADHD risk.

背景：患有 ADHD 的儿童一旦确诊，其医疗保健利用率和年度费用就会增加 2 到 3 倍，但在诊断之前，人们对生命早期的利用模式知之甚少。量化后来被诊断出患有 ADHD 的儿童的早期医疗服务使用情况，可以帮助我们了解这种疾病对早期生活的影响，并揭示与 ADHD 风险较高相关的医疗保健利用模式。方法：来自杜克大学健康系统 (DUHS) 的电子健康记录 (EHR) 数据针对出生于 2006 年 10 月 1 日至 2016 年 10 月 1 日的患者进行了分析。 那些在 1 岁之前至少进行过两次健康儿童就诊的患者被分为 ADHD 或非 ADHD基于追溯计费代码。通过控制性别、种族和民族的逻辑回归，比较了 1 岁前入院、手术、急诊科 (ED) 就诊和门诊就诊的调整优势比 (AOR)。结果：在 29,929 名符合标准的患者中，有 1,315 名 (4.4%) 被确定为 ADHD 诊断。在 1 岁之前，患有 ADHD 的人住院的几率增加了 60%，去急诊室的几率增加了 58%，手术的几率增加了 41%（p <.0001)，包括输血几率增加 4.7 倍 ( p < .0001)。他们也有更多的门诊就诊次数（μ = 14.7 vs. μ = 12.5，p < .0001），包括去看专科医生的几率增加了 52%，去看外科专家的几率增加了 38%，就诊的几率增加了 70%一名新生儿科医生，去看眼科医生的几率增加了 71%（所有 AOR 的p < .0001）。此外，多动症患者因虐待和忽视儿童而就诊的几率增加了 6 倍 ( p = .0010)。结论： 后来被诊断出患有 ADHD 的儿童更有可能在 1 岁之前入院、访问 ED 并访问特定的医疗和外科服务。未来的工作将确定 ADHD 特有的健康相互作用模式，以对 ADHD 风险进行分层。