Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000–23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7–10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups.

Objective Racial disparities in infant health are common in Brazil. Explaining these disparities and identifying the pathways through which they arise is essential for identifying risk factors that can be targeted by policy interventions. Our objective is to quantify the extent to which socioeconomic, healthcare, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. Methods We employ a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focus on disparities in LBW (< 2500 grams) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or mixed with other ancestries on one side, and infants of European ancestry alone on the other. We quantify the contributions of several conceptually relevant factors to these disparities using a decomposition model. Findings The model explains 45-94% and 64-94% of the LBW and PTB disparities, respectively, between the various African ancestry groups and European ancestry. Differences in prenatal care use and geographic location are generally the most important contributors to these disparities, followed by socioeconomic differences. The model explains the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Conclusions Prenatal care and geographic location differences explain a large portion of the health disparities between infants of African and European ancestries. Public policies aiming at improving child health should target these pathways in order to reduce such disparities.

Objectives The purpose of this brief is to describe changes in the treated prevalence of medically managed attention-deficit/hyperactivity disorder (ADHD) among insured school-aged children and adolescents in the United States from 2009 to 2015. We examine the differences between those with employer-sponsored insurance (ESI) and with Medicaid insurance. Methods We utilized two large longitudinal administrative datasets containing medical and drug claims data on individuals with ESI and Medicaid insurance from Truven Health MarketScan® Administrative Claims Databases. Treated prevalence was measured as the percentage of school-aged children and adolescents enrolled in a calendar year who met the criteria for medically managed ADHD in the same calendar year. Subjects were eligible for inclusion if they were aged 6–17 years and were continuously enrolled during a calendar year. Results The annual prevalence of treated ADHD among school-aged children and adolescents with ESI increased from 4.5% in 2009 to 6.7% in 2015. Among those with Medicaid it increased from 11.3% in 2009 to 13.3% in 2012, and fell after 2012, remaining steady from 2013 through 2015. Conclusion Treated prevalence of ADHD increased continuously over time among school-aged children and adolescents with ESI, but declined slightly after 2012 among those in the Medicaid sample.

Several studies report socioeconomic inequalities in child health and consequences of early disease. However, not much is known about inequalities in health capital accumulation in the womb in response to fetal health shocks, which is essential for finding the earliest sensitive periods for interventions to reduce inequalities. We identify inequalities in birth weight accumulation as a result of fetal health shocks from the occurrence of one of the most common birth defects, oral clefts, within the first 9 weeks of pregnancy, using quantile regression and two datasets from South America and the US. Infants born at lower birth weight quantiles are significantly more adversely affected by the health shock compared to those born at higher birth weight quantiles, with overall comparable results between the South American and US samples. These results suggest that fetal health shocks increase child health disparities by widening the spread of the birth weight distribution and that health inequalities begin in the womb, requiring interventions before pregnancy.