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J Prim Care Community Health. 2015 Jan;6(1):2-9. doi: 10.1177/2150131914540916. Epub 2014 Jul 7.

Effect of multiple chronic diseases on health care expenditures in childhood.

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Mayo Clinic, Rochester, MN, USA.
Mayo Clinic, Rochester, MN, USA



To examine multiple chronic conditions and related health care expenditures in children.


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.


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.


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.


children; chronic conditions; comorbidities; medical cost; pediatrics

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