Racial disparities exist in diagnosis, treatment of ADHD

Researchers reported evidence of racial and ethnic disparities in the diagnosis and treatment of ADHD, according to results of a retrospective cohort study published in JAMA Network Open.

“In this study, we constructed a birth cohort of children from a national commercial insurance–based data set to test the hypotheses that non-Hispanic white children have higher cumulative incidence of ADHD diagnosis and that they are more likely to be treated with medications within the first year after diagnosis compared with children from other racial or ethnic groups,” Yu Shi, MD, MPH, of the department of anesthesiology and perioperative medicine at Mayo Clinic, and colleagues wrote. “We also explored whether children had different psychiatric comorbidities associated with ADHD based on race and ethnicity. Unlike previous studies that relied on parental reports, we used clinical diagnostic and billing codes as outcome measures.”

The investigators assessed insurance claims data of 238,011 children, of whom 11,401 were diagnosed with ADHD, born in the United States between January 2006 and December 2012. Those included had continuous insurance coverage for 4 years or longer, and the last follow-up date was June 30, 2019. Self-report classified race/ethnicity designations, which included non-Hispanic white, Black, Hispanic and Asian. ADHD diagnosis according to ICD-9 or ICD-10 codes and treatment within 1 year of diagnosis, including medication and behavior defined according to billing codes, served as the main outcomes and measures. The investigators used a multivariate Cox regression model to adjust data on ADHD diagnosis and treatment for sex, region and household income.

Results showed a cumulative ADHD incidence of 13.12% (95% CI, 12.79-13.46) at age 12 among the participants. Adjusted multivariate Cox regression showed a hazard ratio of 0.48 (95% CI, 0.43-0.53) for Asian children, 0.83 (95% CI, 0.77-0.9) for Black children and 0.77 (95% CI, 0.72-0.82) for Hispanic children vs. white children. A total of 516 preschool children (19.4%) received behavioral therapy only, 860 (32.4%) received medications only, 505 (19%) received both and 774 (29.2%) had no claims associated with either option in the first year after diagnosis. Among school-aged children, more (65.5%) were prescribed medications, and fewer (14.4%) received therapy only or no treatment at all (20%). White children were more likely to receive some form of treatment vs. other groups. Asian children were most likely to receive no treatment, with an odds ratio compared with white children of 0.54 (95% CI, 0.42-0.7).

“Future study is needed to elucidate the mechanism behind these disparities,” Shi and colleagues wrote. “Clinicians should provide racially and culturally sensitive care in the evaluation and treatment of ADHD to ensure all children receive appropriate care.”