title: Effect of multiple chronic diseases on health care expenditures in childhood.
abstract: OBJECTIVE
  To examine multiple chronic conditions and related health care expenditures in children.
  
  
  METHODS
  Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims.
  
  
  RESULTS
  The most prevalent chronic conditions were asthma/chronic obstructive pulmonary disease (12%), allergic rhinitis (11%), and behavior problems (9%). The most costly conditions were congenital anomalies, asthma/chronic obstructive pulmonary disease, and behavior problems ($9602, $4335, and $5378 annual cost per child, respectively). Annual health care expenditures increased substantially with the number of chronic conditions, and a small proportion of children with multiple chronic conditions accounted for a large proportion of health care costs. In addition, those with multiple chronic conditions were more likely to persist in the top 10th percentile spender group in year-to-year spending.
  
  
  CONCLUSIONS
  Children with multiple chronic conditions accounted for a large proportion of health care expenditures. These children were also likely to persist as high spenders in the 4-year time frame. Further research into effective ways to manage the health care delivery for children with multiple chronic conditions is needed.
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Zhong
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Finnie
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagie
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Mayo Clinic, Rochester, MN, USA naessens@mayo.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000191:economics; D002648:Child; D002653:Child Behavior Disorders / Q000191:economics; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics*; D015331:Cohort Studies; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000191:economics
keywords: children; chronic conditions; comorbidities; medical cost; pediatrics