Abstract
There are limited data on the racial disparities in the incidence of attention-deficit/hyperactivity disorder (ADHD) diagnosis in children at the national level. To explore differences in rates of diagnosis of ADHD and use of treatment among children by race and ethnicity. This retrospective cohort study assessed insurance claims data of children born in the US between January 1, 2006, and December 31, 2012, who had continuous insurance coverage for at least 4 years. The last date of follow-up included in the cohort was June 30, 2019. Race/ethnicity designations were based on self-report and included non-Hispanic White, Black, Hispanic, and Asian. Data were analyzed between October 2019 and December 2020. Race and ethnicity. ADHD diagnosis as defined by International Classification of Diseases codes (ninth or tenth editions) and treatment within 1 year of diagnosis, including medication and behavior therapy as defined by billing codes. Data on ADHD diagnosis and treatment were adjusted for sex, region, and household income in a multivariate Cox regression model. Among 238 011 children in the cohort (116 093 [48.8%] girls; 15 183 [6.7%] Asian, 14 792 [6.2%] Black, 23 358 [9.8%] Hispanic, and 173 082 [72.7%] White children), 11 401 (4.8%) were diagnosed with ADHD. The cumulative incidence at age 12 was 13.12% (95% CI, 12.79%-13.46%). In multivariate Cox regression adjusting for sex, region, and household income, the hazard ratio for Asian children was 0.48 (95% CI, 0.43-0.53); Black children, 0.83 (95% CI, 0.77-0.90); and Hispanic children, 0.77 (95% CI, 0.72, 0.82) compared with White children. In the first year after diagnosis, 516 preschool children (19.4%) received behavioral therapy only, 860 (32.4%) had medications only, 505 (19.0%) had both, and 774 (29.2%) had no claims associated with either option. A higher percentage of school-aged children (2904 [65.6%]) were prescribed medications, and fewer had therapy only (639 [14.4%]) or no treatment at all (884 [20.0%]). Compared with other groups, White children were more likely to receive some kind of treatment. Asian children had the highest odds of receiving no treatment (odds ratio compared with White children, 0.54; 95% CI, 0.42-0.70). Racial and ethnic disparities in the diagnosis and treatment of ADHD are evident. Future study is needed to elucidate the mechanism behind these disparities, with special attention to Asian children. Clinicians should provide racially sensitive care in the evaluation and treatment of ADHD.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) affects a large number of children and has long-term effects on their health and learning.[1,2,3] For example, attention-deficit/ hyperactivity disorder (ADHD) is associated with poorer quality of life and higher medical costs.[2,4] Based on data from national surveys, the prevalence of ADHD in the US appears to have increased in the last 2 decades.[5,6] little is known about the incidence of ADHD diagnosis at the national level
In multivariate Cox regression adjusting for sex, region, and household income, the hazard ratio for Asian children was 0.48; Black children, 0.83; and Hispanic children, 0.77 compared with White children
Little is known about the incidence of ADHD diagnosis at the national level
Summary
Attention-deficit/hyperactivity disorder (ADHD) affects a large number of children and has long-term effects on their health and learning.[1,2,3] For example, ADHD is associated with poorer quality of life and higher medical costs.[2,4] Based on data from national surveys, the prevalence of ADHD in the US appears to have increased in the last 2 decades.[5,6] little is known about the incidence of ADHD diagnosis at the national level. Previous studies suggest that racial and ethnic disparities exist in the diagnosis of ADHD. Most studies have reported differences among prevalence of ADHD between racial and ethnic groups, there are discrepancies in the direction of the inequality. Black children may have a higher or lower rate compared with non-Hispanic White children depending on the study.[10,11,12,13,14,15] The underlying mechanism of these disparities is unclear, but it may include socioeconomic and cultural factors, variations in the interpretation of children’s behavior, and the application of diagnostic criteria.[11,16,17,18] Children from different racial groups may have different rates of psychiatric comorbidities.[19]
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