(C23) Racial-Ethnic Differences in ADHD Diagnosis and Pharmacotherapy Among Adolescents and Emerging Adults in a US Commercial Healthcare Claims Database

Publication Number: 967

Background: Racially and ethnically minoritized youth in the United States (US) face barriers to ADHD treatment. While previous research suggests minoritized children are less likely than White children to be diagnosed with ADHD and receive pharmacotherapy, fewer studies have examined racial-ethnic differences during adolescence and emerging adulthood.

Objectives: The objective of this study was to describe racial-ethnic differences in ADHD diagnosis and pharmacotherapy in five age categories spanning adolescence and emerging adulthood.

Methods: We used Optum’s de-identified Clinformatics® Data Mart (CDM) to study administrative healthcare claims for youth aged 12-25 who were continuously enrolled in commercial insurance for at least one year from 2014-2019. We examined racial-ethnic differences in the prevalence of a) ADHD diagnoses, identified using a validated algorithm based on International Classification of Diseases codes, and b) pharmacotherapy among those diagnosed. Race-ethnicity in the CDM is derived from a proprietary algorithm. We defined ADHD pharmacotherapy as filled-prescription claims with National Drug Codes for stimulants, atomoxetine, and alpha-2 agonists. We calculated period prevalence proportions in five age categories, stratified by race-ethnicity. Within each age category, we estimated prevalence ratios (PRs) comparing prevalence in each minoritized racial-ethnic subgroup to that in the non-Hispanic White subgroup. PRs were estimated using Poisson regression with a natural log link.

Results: There were 4,216,757 youth in the study sample (5.2% Asian, 9.0% Black, 14.7% Hispanic, 63.2% White, and 7.8% unknown race-ethnicity), 7.2% of whom met criteria for ADHD. Across all age groups, White youth had a higher diagnosis prevalence than did minoritized youth. At ages 18-20, 10.0% of White youth received ADHD diagnoses, compared to 3.7% of Asian (PR=0.37, 95% CI 0.36-0.38), 5.5% of Black (PR=0.55, 95% CI 0.54-0.56), and 4.2% of Hispanic youth (PR=0.42, 95% CI 0.41-0.43). Among youth with diagnoses, there were smaller relative differences in pharmacotherapy. At ages 18-20, 71.2% of White youth used medications, compared to 66.9% of Asian (PR=0.94, 95% CI 0.91-0.98), 64.8% of Black (PR=0.91, 95% CI 0.89-0.93), and 65.0% of Hispanic youth (PR=0.91, 95% CI 0.89-0.93). Racial-ethnic differences in pharmacotherapy were similar across medication classes.

Conclusions: In this large sample of commercially insured adolescents and young adults, we observed substantial racial-ethnic differences in ADHD diagnosis, with smaller relative differences in pharmacotherapy among those diagnosed. More research is needed to clarify the processes underlying racial-ethnic differences and potential health consequences for minoritized youth.