Diagnoses of neurodevelopmental disorders higher in publicly insured US children

Timing of and risk for childhood neurodevelopment disorder diagnoses is linked to various socioeconomic factors including insurance enrollment, according to a U.S. population-based cohort study published in JAMA Psychiatry.

“Neurodevelopmental disorders are clinically diagnosed by evaluating the presence of aberrant behaviors or delays in achieving developmental milestones and by comparing such behaviors with those of children of the same age, sex, and culture,” Loreen Straub, MD, MS, of the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital, and colleagues wrote.

Straub and colleagues sought to evaluate frequency and intervals of diagnoses for children up to the age of 8, and to assess any differences based on population, since such data on prevalence, age of initial diagnosis, and demographic variations are required to properly identify risk factors and clarify procedures for proper care.

The researchers considered seven different neurodevelopmental disorders, including autism spectrum disorders, ADHD, coordination disorders and behavioral issues. They used Kaplan-Meier analyses to estimate the incidence and timing of a diagnosis, broken down by child’s sex, birth year, maternal age at delivery, and race and ethnicity.

The study utilized data from both the 2000 to 2014 Medicaid Analytic eXtract, as well as the 2003 to 2015 IBM MarketScan Research Database on approximately 3.3 million children, 2,070,541 which were covered by public insurance and 1,309,900 insured privately at birth. Data were analyzed from May 1, 2020, to June 30, 2021. Follow-up was conducted until participants’ continuous eligibility ended, the study period ended, they developed a diagnosis of interest, they reached their 12th birthday, or death.

Results showed that, by 8 years of age, 23.9% of publicly insured children and 11% of privately insured children had been diagnosed with one or more neurodevelopmental disorders.

Overall, boys had a higher risk for diagnosis compared with girls regardless of insurance enrollment status. While information was only available for publicly insured children with respect to race, white children (30.2%) were found to be at higher risk compared with children of other races (23% among Black children, 15.4% among Hispanic children, 9.1% among Asian children and 22.7% among children of unknown race or ethnicity).

Outcomes for diagnosis were varied when considering associations of maternal age and birth year with frequency of neurodevelopmental disorders. Except for ADHD, the diagnosis was shown to occur earlier in life for privately insured children.

The association of race and ethnicity with age at diagnosis also varied by outcome, with commonality for concurrent neurodevelopmental disorders, particularly in children previously diagnosed with ASD and intellectual disability.

“The high incidence of NDDs, coupled with racial and sociodemographic disparities, underscores the importance of raising awareness of providing universal and timely access to psychological and educational services to ensure that diagnosis, intervention, and support can start as soon as possible for all children with NDDs, with the goal of preventing and/or mitigating long-term developmental deficits and economic or other burdens on the family and society,” Straub and colleagues wrote.