Examining ADHD disparities due to race and ethnicity

Over the past several years, health care providers have become increasingly aware of disparities in care as well as diagnosing because of race and ethnicity. A report in JAMA Network Open offers insight onto whether such disparities exist for the diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD).¹

The investigators conducted a retrospective cohort study that use insurance claims data of children who were born in the United States between January 2006 and December 2012 and had continuous insurance coverage for at least 4 years. The final follow-up date for the cohort was June 30, 2019. Race and/or ethnicity information was based on the child’s self-reporting and included non-Hispanic White, Black, Hispanic, and Asian. Coding was used to determine ADHD diagnosis and treatment within a year of diagnosis and included medication and behavior therapy.

From a cohort of 238,011 children, 11,401 children were diagnosed with ADHD. Following the multivariate Cox regression that adjusted for sex, region, and household income, when compared to white children, the hazard ratio for Asian children was 0.48 (95% CI, 0.43-0.53); Black children, 0.83 (95% CI, 0.77-0.90); and Hispanic children, 0.77 (95% CI, 0.72, 0.82). In the year after diagnosis, 516 children who were preschool age were give behavioral therapy only; 860 preschool aged children had medication only; and 505 were given both medication and behavioral therapy. Among school aged children, 2904 were given medication only and 639 had therapy only. Twenty percent of school aged children had no treatment at all. When compared to other race/ethnicity groups, White children were more likely be given some form of treatment and Asian children were the group with the highest odds of being given no treatment (odds ratio compared with White children, 0.54; 95% CI, 0.42-0.70).

The investigators concluded that there are evident disparities due to race or ethnicity in both diagnosis and treatment of ADHD. They urged additional research to determine the mechanism behind the disparities along with research into how to improve both diagnosis and treatment in Asian children.

Reference

1. Shi Y, Guevara L, Dykhoff H, et al. Racial disparities in diagnosis of attention-deficit/hyperactivity disorder in a US national birth cohort. JAMA Netw Open. 2021;4(3):e210321. doi:10.1001/jamanetworkopen.2021.0321