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Marni D Brownell
Ana C de B. Hanlon-Dearman
Leonard R MacWilliam
Albert E Chudley
Noralou P Roos
Lauren P Yallop
Sally E A Longstaffe


FASD, health service utilization, social services, administrative data, special education


Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of intellectual disability in western society, presenting a significant burden on health, education and social services. Quantifying the burden of FASD is important for service planning and policy and program development.

To describe the health, education and social service use of individuals with FASD to provide an indication of the burden of service use of the disorder.

Using a matched-cohort design health, education and social service data were linked with clinical records on individuals 6+ years diagnosed with FASD between 1999/2000-2009/10 (N=717). Matching was 2:1 with a general population (gPop) and asthma group by age, sex and area-level income. Adjusted rates and relative risks were calculated using Generalized Linear Models.

Hospitalizations were higher in the FASD compared to gPop (adjusted relative risk=3.44 (95% confidence interval=2.29, 5.17)) and asthma (2.87 (1.94, 4.25)) groups, whereas for physician visits and overall prescriptions, the FASD group differed from only the gPop group (1.58 (1.34, 1.84); 1.44 (1.22, 1.72), respectively). Antibiotics, pain killers and anti-psychotics were similar across groups whereas antidepressants and psychostimulants were higher in the FASD group (antidepressants: FASD vs. gPop 8.76 (2.82, 27.21); FASD vs. asthma 2.10 (1.15, 3.83); psychostimulants: FASD vs. gPop 5.78 (2.89, 11.57); FASD vs. asthma 2.47 (1.37, 4.47)). Attention-deficit\hyperactivity disorder was higher in the FASD than the gPop and asthma groups (6.41 (3.29, 12.49); 3.12 (1.97, 4.93), respectively). Education and social service use was higher for the FASD than either of the other groups for all measures (FASD vs. gPop and FASD vs. asthma, respectively for: grade repetition 3.06 (1.58, 5.94); 3.48 (1.79, 6.78); receipt of any special education funding 9.22 (6.23, 13.64); 6.10 (4.14, 8.99); family receipt of income assistance 1.74 (1.33, 2.27); 1.89 (1.45, 2.47); child in care 13.19 (5.84, 29.78);10.70 (4.80, 23.88); and receipt of child welfare services 5.70 (4.21, 7.71); 4.94 (3.67, 6.66)).

The health, education and social service utilization burden of individuals with FASD is substantial, greater than that of individuals in the general population and with chronic illness (i.e., asthma). The findings highlight the need for multisystem supports for those with FASD, and comprehensive prevention programs.

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1. Sokol RJ, Delaney-Black V, Nordstrom B. Fetal alcohol spectrum disorder. JAMA Dec 10 2003;290(22):2996-2999.
2. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ Mar 1 2005;172(5 Suppl):S1-S21.
3. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr Aug 2004;25(4):228-238.
4. Fast DK, Conry J. The challenge of fetal alcohol syndrome in the criminal legal system. Addict Biol Jun 2004;9(2):161-166; discussion 167-168.
5. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with fetal alcohol spectrum disorder. Child Neuropsychol Dec 2006;12(6):453-468.
6. May PA, Fiorentino D, Coriale, G, Kalberg WO, Hoyme HE, Aragon AS, Buckley D, Stellavato C, Gossage JP, Robinson LK, Jones KL, Manning M, Ceccanti M. Prevalence of children with severe fetal alcohol spectrum disorders in communities near Rome, Italy: new estimated rates are higher than previous estimates. Int J of Environmental Res and Public Health 2011;8(6): 23312351;doi: 10.3390/ijerph8062331
7. May PA, Gossage JP, Kalberg WO, et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev 2009;15(3):176-192.
8. Stade B, Ungar WJ, Stevens B, Beyen J, Koren G. Cost of fetal alcohol spectrum disorder in Canada. Can Fam Physician Aug 2007;53(8):1303-1304.
9. Popova S, Stade B, Bekmuradov D, Lange S, Rehm J. What do we know about the economic impact of fetal alcohol spectrum disorder? A systematic literature review. Alcohol Alcohol Jul-Aug 2011;46(4):490-497.
10. Popova S, Lange S, Burd L, Rehm J. Health care burden and cost associated with Fetal Alcohol Syndrome: based on official Canadian data. PLoS ONE 2012;7(8): e43024. doi: 10.1371/ journal.pone.0043024.
11. Brownell MD, Roos NP, Roos LL. Monitoring healthcare reform: A report card approach. Social Science & Medicine 2001;52:657-670.11.
12. Jutte DP, Roos LL, Brownell MD. Administrative record linkage as a tool for public health. Annu Rev Public Health 2010; 32:91-108.
13. Kozyrskyj AL, Mustard CA. Validation of an electronic, population-based prescription database. Ann Pharmacotherapy 1998;32:1152-7.
14. Oreopoulos P, Stabile M, Walld R, Roos LL Short, medium, and long term consequences of poor infant health: an analysis using siblings and twins. Journal of Human Resources 2008;43:88-138.
15. Robinson JR, Young TK, Roos LL, Gelskey DE: Estimating the burden of disease: comparing administrative data and self-reports. Med Care 1997;35(9):932-47.
16. Roos LL, Gupta S, Soodeen R, Jebamani L. Data quality in an information-rich environment: Canada as an example. Can J Aging 2005;24 (Suppl.1):153-70.
17. Roos LL, Menec V, Currie RJ. Policy analysis in an information-rich environment. Soc Sci Med 2004;58(11): 2231-41.
18. Roos LL, Nicol JP. A research registry: Uses, development, and accuracy. J Clin Epidemiol 1999;52(1):39-47.
19. Roos LL, Nicol JP, Cageorge SM. Using administrative data for longitudinal research: Comparisons with primary data collection. J Chronic Dis 1987;40:41-9.
20. Kozyrskyj AL, HayGlass KT, Sandford AJ, Pare PD, Chan-Yeung M, Becker AB. A novel study design to investigate the early-life origins of asthma in children (SAGE study). Allergy 2009;64: 1185-1193.
21. Kozyrkyj AL, Mustard CA, Becker AB. Childhood wheezing syndromes and healthcare data. Pediatric Pulmonology 2003;36:131-136.
22. Kozyrskyj AL, Mustard CA, Becker AB. Identifying children with persistent asthma from health care administrative records. Can Respir J 2004;11(2):141-145
23. Fuchs D, Burnside L, Marchenski S, Mudry A. Children with FASD involved with the Manitoba child welfare system 2007. Available at: