title: Health resource utilization varies by comorbidities in children with epilepsy.
abstract: OBJECTIVE
  Comorbidities in adults with epilepsy have been shown to significantly increase health resource utilization (HRU). The current study aimed to determine whether a similar association exists among children with epilepsy in a universal health insurance system.
  
  
  METHODS
  Health administrative databases in Ontario, Canada were used to evaluate the frequency of neurologist visits, emergency department (ED) visits, and hospitalizations. We evaluated the association between HRU and comorbidities, including depression, anxiety, learning disability, attention deficit hyperactivity disorder (ADHD), and autistic spectrum disorder (ASD), adjusting for age, sex, residence, and socio-economic status.
  
  
  RESULTS
  The frequency of neurology visits was increased by comorbid depression, ASD, and learning disability (adjusted relative risk [aRR]=1.29-2.07; p<.01). The frequency of ED visits was increased by all comorbidities (aRR=1.26-2.83; p<.0001). The frequency of hospitalizations was increased by comorbid depression, anxiety, ASD, and learning disability (aRR=1.77-7.20; p<.0001). Learning disability had the largest impact on HRU. For each additional comorbidity, the frequency of neurology visits, ED visits, and hospitalizations increased by 1.64 to 3.16 times (p<.0001).
  
  
  CONCLUSIONS
  Among children with epilepsy, mental health and developmental comorbidities were associated with increased HRU, and different comorbidities influenced different types of HRU. In addition, we highlight the importance of identifying and managing these comorbidities, as they increased the risks of costly HRU such as ED visits and hospitalizations.
authors.affiliation: Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Klajdi
authors.initials: K
authors.lastname: Puka
authors.affiliation: Department of Psychology, Hospital for Sick Children, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada; Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada. Electronic address: elysa.widjaja@sickkids.ca.
authors.forename: Elysa
authors.initials: E
authors.lastname: Widjaja
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity; D002170:Canada / Q000453:epidemiology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D004827:Epilepsy / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007859:Learning Disabilities; D008297:Male; D008603:Mental Health; D012923:Social Class
keywords: Developmental comorbidity; Health service utilization; Mental health; Pediatric; Population study