title: Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study.
abstract: BACKGROUND
  Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining whether longitudinal resource use is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care use associated with constipation from childhood to early adulthood.
  
  
  METHODS
  A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5718 children in a population-based birth cohort who were born during 1976 to 1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all noncases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5 and 18 years of age or until the subject emigrated from the community.
  
  
  RESULTS
  We identified 250 cases with a diagnosis of constipation in the birth cohort. Although the mean inpatient costs for cases were $9994 (95% Confidence interval [CI] 2538-37,201) compared with $2391 (95% CI 923-7452) for controls (P = 0.22) during the time period, the mean outpatient costs for cases were $13,927 (95% CI 11,325-16,525) compared with $3448 (95% CI 3771-4621) for controls (P < 0.001) during the same time period. The mean annual number of emergency department visits for cases was 0.66 (95% CI 0.62-0.70) compared with 0.34 (95% CI 0.32-0.35) for controls (P < 0.0001).
  
  
  CONCLUSIONS
  Individuals with constipation have higher medical care use. Outpatient costs and emergency department use were significantly greater for individuals with constipation from childhood to early adulthood.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rok Seon
authors.initials: RS
authors.lastname: Choung
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Denesh
authors.initials: D
authors.lastname: Chitkara
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.forename: Miranda A
authors.initials: MA
authors.lastname: Van Tilburg
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.forename: Slavica K
authors.initials: SK
authors.lastname: Katusic
authors.forename: G Richard
authors.initials: GR
authors.lastname: Locke
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003248:Constipation / Q000191:economics*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008910:Minnesota; D015999:Multivariate Analysis; D055815:Young Adult