Dataset Information

Racial and Ethnic Disparities in ADHD Diagnosis and Treatment.

ABSTRACT: We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children.We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logistic regression examined disparities in parent-reported ADHD diagnosis and medication use in the following analyses: (1) using the total sample; (2) limited to children with an ADHD diagnosis or symptoms; and (3) limited to children without a diagnosis or symptoms.Across all waves, African-American and Latino children, compared with white children, had lower odds of having an ADHD diagnosis and of taking ADHD medication, controlling for sociodemographics, ADHD symptoms, and other potential comorbid mental health symptoms. Among children with an ADHD diagnosis or symptoms, African-American children had lower odds of medication use at fifth, seventh, and 10th grades, and Latino children had lower odds at fifth and 10th grades. Among children who had neither ADHD symptoms nor ADHD diagnosis by fifth grade (and thus would not likely meet ADHD diagnostic criteria at any age), medication use did not vary by race/ethnicity in adjusted analysis.Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade. These findings suggest that disparities may be more likely related to underdiagnosis and undertreatment of African-American and Latino children as opposed to overdiagnosis or overtreatment of white children.

SUBMITTER: Coker TR

PROVIDER: S-EPMC5684883 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Racial and Ethnic Disparities in ADHD Diagnosis and Treatment.

Coker Tumaini R TR Elliott Marc N MN Toomey Sara L SL Schwebel David C DC Cuccaro Paula P Tortolero Emery Susan S Davies Susan L SL Visser Susanna N SN Schuster Mark A MA

Pediatrics 20160823 3

<h4>Objectives</h4>We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children.<h4>Methods</h4>We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logisti ...[more]

PMID: 27553219

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Project description:BackgroundThere exist racial and ethnic disparities in the prevalence of chronic medical illnesses. However, it is unclear if the disparities arise from patients' self-reported estimates on these diseases and whether there is an association between healthcare utilization and diagnosis.ObjectiveTo estimate national racial/ethnic prevalence of undiagnosed hypertension, diabetes, high cholesterol, and kidney disease and identify characteristics associated with undiagnosed diseases.DesignRetrospective analysis of multi-year survey data.ParticipantsAdults 18 years and older who participated in the National Health and Nutrition Examination Survey during 2011-2014 (n = 10,403).Main outcomesUndiagnosed hypertension (SBP ≥ 140 or DBP ≥ 90 on physical examination with no history of hypertension), undiagnosed diabetes (hgba1c ≥ 6.5% with no history of diabetes), undiagnosed high cholesterol (LDL ≥ 160 mg/dL with no history of high cholesterol), and undiagnosed kidney disease (eGFR ≤ 30 with no history of kidney disease).ResultsThe study sample was categorized into Whites, Blacks, Hispanics, Asians, and Other. After adjusting for sociodemographic characteristics, Asians had increased odds of undiagnosed hypertension (OR = 1.41 [1.06-1.86]) and diabetes (OR = 6.16 [3.76-10.08]) compared to Whites. Blacks (OR = 2.53 [1.71-3.73]) and Hispanics (OR = 1.88 [1.19-2.99]) had increased odds of undiagnosed diabetes compared to Whites. Multivariate logistic regression analysis indicated that not having any health insurance was associated with increased odds of undiagnosed diabetes and hyperlipidemia (OR = 1.56 [1.00-2.44] and OR = 2.08 [1.44-3.00], respectively). A recent healthcare visit was associated with a lower likelihood of having undiagnosed hypertension (OR = 0.58 [0.41-0.83]) and diabetes (OR = 0.35 [0.18-0.69]).ConclusionsIn a nationally representative cohort, Asians had higher rates of undiagnosed hypertension and diabetes, and all minorities were more likely to have undiagnosed diabetes compared to Whites. Healthcare utilization was associated with undiagnosed medical conditions. Our study showed that reliance on self-reported data may systemically underestimate the prevalence of chronic illnesses among minorities and further research is needed to understand the significance of healthcare utilization in health outcomes.

Project description:ImportanceThe US aging population is rapidly becoming more racially and ethnically diverse. Early diagnosis of dementia is a health care priority.ObjectiveTo examine the associations between race/ethnicity and timeliness of dementia diagnosis and comprehensiveness of diagnostic evaluation.Design, setting, and participantsThis retrospective cross-sectional study used 2013-2015 California Medicare fee-for-service data to examine the associations of race/ethnicity, individual factors, and contextual factors with the timeliness and comprehensiveness of dementia diagnosis. Data from 10 472 unique beneficiaries were analyzed. The sample was selected on the basis of the following criteria: presence of 1 or more claims; no diagnoses of dementia or mild cognitive impairment in 2013 to 2014; continuous enrollment in Medicare Parts A and B; Asian, Black, Hispanic, or White race/ethnicity; and incident diagnoses of dementia or mild cognitive impairment in January through June 2015. Data analyses were conducted from November 1, 2019, through November 10, 2020.Main outcomes and measuresTimeliness of diagnosis, defined as incident diagnosis of mild cognitive impairment vs dementia, and comprehensiveness of diagnostic evaluation, defined as presence of the following services in claims within 6 months before or after the incident diagnosis date: specialist evaluation, laboratory testing, and neuroimaging studies.ResultsThe sample comprised 10 472 unique Medicare beneficiaries with incident diagnoses of dementia or mild cognitive impairment (6504 women [62.1%]; mean [SD] age, 82.9 [8.0] years) and included 993 individuals who identified as Asian (9.5%), 407 as Black (3.9%), 1255 as Hispanic (12.0%), and 7817 as White (74.6%). Compared with White beneficiaries, those who identified as Asian (odds ratio, 0.46; 95% CI, 0.38-0.56), Black (odds ratio, 0.73; 95% CI, 0.56-0.94), or Hispanic (odds ratio, 0.62; 95% CI, 0.52-0.72) were less likely to receive a timely diagnosis. Asian beneficiaries (incidence rate ratio, 0.81; 95% CI, 0.74-0.87) also received fewer diagnostic evaluation elements. These associations remained significant after adjusting for age, sex, comorbidity burden, neighborhood disadvantage, and rurality.Conclusions and relevanceThese findings highlight substantial disparities in the timeliness and comprehensiveness of dementia diagnosis. Public health interventions are needed to achieve equitable care for people living with dementia across all racial/ethnic groups.

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Racial and Ethnic Disparities in ADHD Diagnosis and Treatment.

Publications

Racial and Ethnic Disparities in ADHD Diagnosis and Treatment.

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