, et al
Increased health care utilisation in international adoptees
Dan Med J

Investigators from the University of Copenhagen conducted a study to determine if international adoptees (IA) in Denmark had increased health care utilization compared to nonadoptees. Study participants included IAs who were adopted from 1994–2005, under 11 years of age at the time of their adoption, and who were unrelated to their adoptive parent(s). These study participants were identified by reviewing data in the Danish Civil Registration System. For each study IA child, nonadopted children from the same municipality were selected to serve as controls by reviewing the Danish Family Relations Database. Health care utilization data, categorized as primary or subspecialty services in the early postadoption period (defined as the first 2 years following adoption) and the late postadoption period (defined as the 3 years following the early postadoption period), were abstracted from national health services databases for both IAs and controls. Study outcomes included primary health care utilization and secondary health care use (for selected conditions) in the early and late postadoption periods. These outcomes were compared in IA and control children with regression models after controlling for confounding variables. In addition, analyses for the late period were also adjusted for hospitalization in the early postadoption period to account for excess morbidity in IA children.

Of nearly 500,000 participants, 6,280 were IAs and 492,374 were controls. The majority of IA children were 1 year of age (42.4%) or 2–4 years of age (40.5%) at the time of adoption. IA children commonly arrived from Eastern Asia (41% of the IA participants), South America (24%), or the Indian subcontinent (19%). The IA participants used primary care significantly more than controls in both the early and late postadoption periods. Utilization of secondary health care services for malformations/deformations, burns/corrosions, and consequences of external causes was significantly more common among IA participants than controls in both postadoption phases. Utilization of services for mental/behavioral issues among IA participants was significantly more common in the late, but not the early, postadoption phase. Conversely, secondary health care utilization for diseases of the blood and blood-forming organs (anemia), was significantly more common in the early postadoptive phase among IA children, but not in the late phase, suggesting resolution of these issues.

The investigators conclude that IA is associated with increased health care utilization; while some conditions show a postadoption recovery, others continue to require long-term services. In addition, the investigators suggest that children adopted internationally should be recognized as a vulnerable group with a potential for long-term special health care needs.

It is common for IA children to have infectious diseases, developmental delay, nutritional deficiencies, or other health issues as a result of adverse living conditions in their home countries.1–3  Institutionalization, poverty, pre/postnatal exposures, and malnutrition have all been found to be factors in the poor health of the IA child.2–...

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