1. Addressing Racial/Ethnic Differences in ADHD Diagnosis and Treatment Among Medicaid-insured Youth in California Dinci Pennap, MPH, 1 Mehmet Burcu, MS, 1 Daniel J. Safer, MD, 2 Julie M. Zito, PhD 1,3 MARYLAND CENTER FOR EXCELLENCE IN REGULATORY SCIENCE & INNOVATION Background Population based studies of Medicaid administrative claims data document mental health service utilization in youth on the order of 50% - 60% lower among minority populations Residential locale can be measured in terms of the degree to which two or more racial groups live separately from one another in a geographic area. Residential segregation ‡ may imply differences in access and availability of services as well as cultural preferences that limit use of medical care Objective To assess whether residential segregation of Hispanic youth contributes to reduced treatment services for continuously enrolled Medicaid-insured youth in a large U.S. state Methods Study Design & Population A cross-sectional design was applied to the 2009 claims data of continuously enrolled youth 2 through 17 years of age, representing 83.7% of the state’s Medicaid youth population (N = 2,221,010) Outcomes ADHD diagnosis ICD-9-CM codes (314.xx) from outpatient and physician files Stimulant use At least 1 dispensing for methylphenidate or amphetamine salts Residential Segregation Measure As a proxy for residential segregation, regional Hispanic composition was measured as a proportion of the Hispanic population in the Medicaid enrollee’s zip code of residence; characterized as less than 25%, 25-50%, and >50% Covariates Age group, gender, Medicaid eligibility category, and median household income Results Continuously enrolled Medicaid-insured youth were predominately Hispanic (63.7%), <10 years old (54.2%), & eligible for Medicaid based on low family income (89.9%) Overall, among ADHD diagnosed youth, 59.8% received at least 1 stimulant dispensing. Compared to White youth, Hispanic youth were 32% less likely to receive stimulant treatment following an ADHD diagnosis (Table 1) After adjusting for covariates, the Hispanic to White differences in ADHD diagnosis and stimulant use were significantly reduced as regional Hispanic composition increased from 50% of the enrollees’ zip code of residence (Table 2) Hispanic youth residing in highly segregated areas (>50% Hispanic composition) were: More likely to have median household income <$50,000 (data not shown) 66% less likely to receive an ADHD diagnosis and 35% less likely to receive a stimulant dispensing compared to White youth (Table 2) Conclusions Hispanic to White differences intensified with increasing levels of regional Hispanic composition Among ADHD diagnosed youth, Hispanic to White differences in stimulant use were substantially smaller than the differences in ADHD diagnosis Residential segregation research should be pursued further 1 Departments of Pharmaceutical Health Services Research and 3 Psychiatry, University of Maryland, Baltimore, MD 2 Departments of Psychiatry and Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD Statistical Analyses Bivariate analyses were conducted to assess: 1) percent prevalence of ADHD diagnosis; 2) percent of stimulant use among ADHD diagnosed youth Multivariable analyses were used to examine Hispanic to White differences in ADHD diagnosis and stimulant use across levels of Hispanic residential segregation, adjusting for study covariates N% PrevalenceAOR95% CI ADHD Diagnosis47,3642.1 Race/Ethnicity White16,5605.01.00Ref. Black 7,8493.40.650.63 – 0.67 Hispanic17,2811.20.360.35 – 0.37 Other 5,6742.30.390.38 – 0.40 Stimulant Use28,33459.8 Race/Ethnicity White10,88765.71.00Ref. Black4,45856.80.670.63 – 0.71 Hispanic9,48854.90.680.65 – 0.72 Other3,50161.70.770.72 – 0.83 Table 1. Prevalence and adjusted odds ratio (AOR) of ADHD diagnosis and percent of stimulant use among Medicaid-insured youth in California in 2009 Table 2. Prevalence and adjusted odds ratio (AOR) of ADHD diagnosis and percent of stimulant use in White and Hispanic youth by regional Hispanic composition Regional Hispanic Composition < 25%25% - 50%> 50% %AOR95% CI%AOR95% CI%AOR95% CI ADHD Diagnosis White4.91.00Ref.5.11.00Ref.5.11.00Ref. Hispanic1.70.430.41 – 0.461.40.370.36 – 0.381.10.340.33 – 0.35 Stimulant Use White66.81.00Ref.65.21.00Ref.64.81.00Ref. Hispanic61.40.800.71 – 0.8956.70.710.65 – 0.7653.00.650.60 – 0.71 Limitation Generalizability: Although comprehensive at the state level, the data source represents only 14.6% of national Medicaid-insured youth ‡White, K, Haas, J.S, Williams, D.R. (2012). Health Services Research 47:3