Medical Expenditures for Children with an Autism Spectrum Disorder in a Privately Insured Population

Health Services Research and Evaluation Branch, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.34). 04/2008; 38(3):546-52. DOI: 10.1007/s10803-007-0424-y
Source: PubMed


This study provides estimates of medical expenditures for a subset of children and adolescents who receive employer-based health insurance and have a medical diagnosis of an autism spectrum disorder (ASD). Data analyzed were from the 2003 MarketScan research databases. Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110-$6,200 per year. On average, medical expenditures for individuals with an ASD were 4.1-6.2 times greater than for those without an ASD. Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4-9.5 times greater. These findings add to a growing body of evidence that children and adolescents with medical diagnoses of an ASD incur elevated medical utilization and costs.

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    • "Our findings support the possibility of an effect of maternal exposure to air pollution during pregnancy, and especially during the third trimester, on the development of ASD in her child. It suggests that air pollution is a modifiable risk factor for autism, and reduced exposure during pregnancy could lead to lower incidence of ASD and reduce the substantial, increasing economic burden of ASD on families and on society (Croen et al. 2006; Leslie and Martin 2007; Mandell et al. 2006; Raz et al. 2013; Shimabukuro et al. 2008). Understanding the biological mechanism that may underlie the association by which PM exposure and ASD could provide important insight to ASD pathogenesis. "
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    ABSTRACT: Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet with unclear etiology. To explore the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child. We conducted a nested case-control study of participants in the Nurses' Health Study II (NHS II), a prospective cohort of 116,430 US female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants' children born 1990-2002 with ASD (n=245), and children without ASD (n=1522) randomly selected using frequency matching for birth years. ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤2.5 µm (PM2.5) and 2.5-10 µm (PM10-2.5) were predicted from a spatiotemporal model for the continental US and linked to residential addresses. PM2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range higher PM2.5 (4.42 µg/m(3)) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, while the association with the 9 months of pregnancy remained (OR=1.63; 95% CI: 1.08-2.47). The association between ASD and PM2.5 was stronger for exposure during the third trimester (OR=1.42 per inter-quartile range increase in PM2.5, 95% CI: 1.09, 1.86) than other trimesters (ORs 1.06 and 1.00) when mutually adjusted. There was little association between PM10-2.5 and ASD. Higher maternal exposure to PM2.5 during pregnancy, in particular the third trimester, was associated with greater odds of her child having ASD.
    Environmental Health Perspectives 12/2014; 123(3). DOI:10.1289/ehp.1408133 · 7.98 Impact Factor
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    • "Medical expenditures on individuals with ASD in the US are 4.1–6.2× greater than for those without, with average annual healthcare expenditures of approximately $6000/child reported and precipitously rising [6] [7]. Phenotypic analyses of male biased cognitive disorders suggest that genetic influences increase susceptibility to multiple cognitive deficits [8] [9] [10]. "
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    ABSTRACT: It has been postulated that androgen overexposure in a susceptible person leads to excessive brain masculinization and the autism spectrum disorder (ASD) phenotype. In this study, the responses to estradiol (E2), dihydrotestosterone (DHT), and dichlorodiphenyldichloroethylene (DDE) on B-lymphocytes from ASD subjects and controls are compared. B cells were obtained from 11 ASD subjects, their unaffected fraternal twins, and nontwin siblings. Controls were obtained from a different cell bank. Lactate dehydrogenase (LDH) and sodium 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) reduction levels were measured after incubation with different concentrations of E2, DHT, and DDE. XTT/LDH ratio, representative of mitochondria number per cell, was calculated. E2, DHT, and DDE all cause "U"-shaped growth curves, as measured by LDH levels. ASD B cells show less growth depression compared to siblings and controls (P < 0.01). They also have reduced XTT/LDH ratios (P < 0.01) when compared to external controls, whereas siblings had values of XTT/LDH between ASD and external controls. B-lymphocytes from people with ASD exhibit a differential response to E2, DHT, and hormone disruptors in regard to cell growth and mitochondrial upregulation when compared to non-ASD siblings and external controls. Specifically, ASD B-lymphocytes show significantly less growth depression and less mitochondrial upregulation when exposed to these effectors. A mitochondrial deficit in ASD individuals is implied.
    Journal of Toxicology 11/2013; 2013(11):159810. DOI:10.1155/2013/159810
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    • "In the USA individuals with ASD have medical expenditures 4.1–6.2x greater than those without ASD, with median expenditures being almost 9 times greater [5] [6]. ASD is usually diagnosed before 4 years of age and has a 5 : 1 male to female gender bias. "
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    ABSTRACT: The role of thimerosal containing vaccines in the development of autism spectrum disorder (ASD) has been an area of intense debate, as has the presence of mercury dental amalgams and fish ingestion by pregnant mothers. We studied the effects of thimerosal on cell proliferation and mitochondrial function from B-lymphocytes taken from individuals with autism, their nonautistic twins, and their nontwin siblings. Eleven families were examined and compared to matched controls. B-cells were grown with increasing levels of thimerosal, and various assays (LDH, XTT, DCFH, etc.) were performed to examine the effects on cellular proliferation and mitochondrial function. A subpopulation of eight individuals (4 ASD, 2 twins, and 2 siblings) from four of the families showed thimerosal hypersensitivity, whereas none of the control individuals displayed this response. The thimerosal concentration required to inhibit cell proliferation in these individuals was only 40% of controls. Cells hypersensitive to thimerosal also had higher levels of oxidative stress markers, protein carbonyls, and oxidant generation. This suggests certain individuals with a mild mitochondrial defect may be highly susceptible to mitochondrial specific toxins like the vaccine preservative thimerosal.
    Journal of Toxicology 06/2013; 2013(5):801517. DOI:10.1155/2013/801517
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