OBJECTIVES: This study aimed to systematically summarise all global evidence on the economic burden of ADHD.
METHODS: A systematic search for published studies on costs of ADHD was conducted in EconLit, EMBASE, PubMed, ERIC, and PsycINFO. Additional literature was identified by searching the reference lists of eligible studies. The quality of the studies was assessed using the Larg and Moss checklist.
RESULTS: This review included 44 studies. All studies were conducted in high-income countries and were limited to North America and Europe except for four studies: two in Asia and two in Australia. Most studies were retrospective and undertook a prevalence-based study design. Analysis revealed a substantial economic impact associated with ADHD. Estimates based on total costs ranged from $US831.38 to 20,538 for per person estimates and from $US356 million to 20.27 billion for national estimates. Estimates based on marginal costs ranged from $US244.15 to 18,751.00 for per person estimates and from $US12.18 million to 141.33 billion for national estimates. Studies that calculated economic burden across multiple domains of direct, indirect, and education and justice system costs for both children and adults with ADHD reported higher costs and translated gross domestic product than did studies that captured only a single domain or age group.
CONCLUSIONS: Despite the wide variation in methodologies in studies reviewed, the literature suggests that ADHD imposes a substantial economic burden on society. There is a dire need for cost-of-illness research in low- and middle-income countries to better inform the treatment and management of ADHD in these countries. In addition, guidelines on the conduct and reporting of economic burden studies are needed as they may improve standardisation of cost-of-illness studies.
METHODS: Age, sex, and visual acuity were recorded and spectral domain OCT and ultra-wide-field images of the macula and retina were reviewed in a consecutive series of 74 adults with sickle cell disease.
RESULTS: The median age was 37 years (range 19-73 years) and 36 cases (48.6%) were male. SCM was present in at least 1 eye of 40 cases (54.1%) or in 67 of all eyes (42.3%). SCM prevalence was 54.8%, 62.5%, and 25% for the HbSS, HbSC, and HbS/BThal or other genotypes, respectively. SCM was observed in 41 (39.4%) of the eyes with PSR stages 0, 1, and 2, and in 21 (51.2%) of the eyes with PSR stages 3, 4, and 5, respectively. Mild visual impairment or worse was present in 3 eyes (4.8%) with SCM but this was secondary to other pathology.
CONCLUSION: SCM is a frequent finding in the eyes of adults with sickle cell disease. The prevalence is similar for the HbSS and HbSC genotypes and is not related to the PSR stage. High-contrast distance visual acuity is typically preserved.
OBJECTIVE: To examine ethnic differences in participation in medical check-ups among the elderly.
DESIGN: A nationally representative data set was employed. Multiple logistic regressions were utilised to examine the relationship between ethnicity and the likelihood of undergoing medical check-ups. The regressions were stratified by age, income, marital status, gender, household location, insurance access and health status. These variables were also controlled for in the regressions (including stratified regressions).
PARTICIPANTS: The respondents were required to be residents of Malaysia and not be institutionalised. Overall, 30,806 individuals were selected to be interviewed, but only 28,650 were actually interviewed, equivalent to a 93% response rate. Of those, only 2248 were used in the analyses, because 26,402 were others or below aged 60.
MAIN MEASURES: The dependent variable was participation in a medical check-up. The main independent variables were the three major ethnic groups in Malaysia (Malay, Chinese, Indian).
KEY RESULTS: Among the elderly aged 70-79 years, Chinese (aOR 1.89; 95% CI 1.28, 2.81) and Indians (aOR 2.39; 95% CI 1.20, 4.74) were more likely to undergo medical check-ups than Malays. Among the elderly with monthly incomes of ≤ RM999, Chinese (aOR 1.44; 95% CI 1.12, 1.85) and Indians (aOR 1.50; 95% CI 0.99, 2.28) were more likely to undergo medical check-ups than Malays. Indian males were more likely to undergo medical check-ups than Malay males (aOR 2.32; 95% CI 1.15, 4.67). Chinese with hypercholesterolaemia (aOR 1.45; 95% CI 1.07, 1.98) and hypertension (aOR 1.32; 95% CI 1.02, 1.72) were more likely to undergo medical check-ups than Malays.
CONCLUSIONS: There were ethnic differences in participation in medical check-ups among the elderly. These ethnic differences varied across age, income, marital status, gender, household location, insurance access and health status.