Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study

Kerstin Gerhold; Saeed Al-Azazi; Wael El-Matary; Laurence Y Katz; Lily S H Lim; Seth D Marks; Lisa M Lix

doi:10.1016/j.jpeds.2024.114046

Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study

J Pediatr. 2024 Apr 4:271:114046. doi: 10.1016/j.jpeds.2024.114046. Online ahead of print.

Authors

Kerstin Gerhold¹, Saeed Al-Azazi², Wael El-Matary³, Laurence Y Katz⁴, Lily S H Lim⁵, Seth D Marks³, Lisa M Lix⁶

Affiliations

¹ Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA; Mississippi Center for Advanced Medicine, Madison, MS. Electronic address: kgerhold@msadvancedmedicine.com.
² George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Manitoba, CA.
³ Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA.
⁴ Rady Faculty of Health Sciences, Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Manitoba, CA.
⁵ Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA.
⁶ Rady Faculty of Health Sciences, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Manitoba, CA.

PMID: 38582149
DOI: 10.1016/j.jpeds.2024.114046

Abstract

Objectives: To understand the burden associated with pediatric chronic pain (CP) on the health care system compared with other costly chronic diseases prior to subspecialty care.

Study design: In this retrospective cohort study, we assessed all-cause health care utilization and direct health care costs associated with pediatric CP (n = 91) compared with juvenile arthritis (n = 135), inflammatory bowel disease (n = 90), type 1 diabetes (n = 475) or type 2 diabetes (n = 289), anxiety (n = 7193), and controls (n = 273) 2 and 5 years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in health care utilization and direct health care costs associated with CP vs the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively.

Results: After adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (P < .01, respectively). CP was significantly associated with higher physician costs than juvenile arthritis, inflammatory bowel disease, type 1 diabetes, type 2 diabetes, or controls (P < .01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (P < .01, respectively).

Conclusion: Compared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the health care system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.

Keywords: adolescents; anxiety; children; inflammatory bowel disease; juvenile arthritis; type 1 diabetes; type 2 diabetes.