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Articles   |    
Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008
Douglas C. McDonald, Ph.D.; Sarah Kuck Jalbert, M.A., M.S.
Psychiatric Services 2013; doi: 10.1176/appi.ps.004442012
View Author and Article Information

The authors are with the United States Health Division, Abt Associates, Inc., 55 Wheeler St., Cambridge, MA 02138 (e-mail: doug_mcdonald@abtassoc.com).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study estimated the prevalence of stimulant treatment among both adults and children at national, state, and county levels during 2008 and explored explanations for wide variations in treatment prevalence.

Methods  Records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients were obtained from approximately 76% of U.S. retail pharmacies. Data were weighted to estimate treatment prevalence on March 15, 2008, for all U.S. states and counties. Regression models were used to estimate the associations among the counties’ treatment rates and the characteristics of the counties and their resident populations.

Results  An estimated 2.5% of children ≤17 years of age (3.5% of males and 1.5% of females) and .6% of persons >17 years of age were being treated with stimulants in March 2008. Treatment prevalence among states varied widely, and variation among counties was even wider. Two-thirds of the variation among counties in treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education. Rates of children and adults in treatment were highly correlated.

Conclusions  Wide variations in treatment prevalence signal disparities between established clinical practice guidelines and actual practice, especially for primary care, where most patients prescribed stimulants are managed. Better education and training for physicians may improve identification and treatment, thereby reducing disparities in care for attention-deficit hyperactivity disorder and other disabling conditions.

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Figure 1 Percentage of children ≤17 years old treated with stimulants in 2008, by statea

aData are standardized by age and gender. The bold horizontal line indicates average national treatment rate.

Figure 2 Percentage of adults >17 years old treated with stimulants in 2008, by statea

aData are standardized by age and gender. The bold horizontal line indicates average national treatment rate.

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Table 1Variation among states and counties in percentages of children and adults treated with stimulant drugs in March 2008a
Table Footer Note

a Percent of persons in treatment derived from LRx Data, 2008, provided by IMS Health, and from 2008 population estimates for states and counties, standardized by age and gender, from the U.S. Census Bureau

Table Footer Note

b Coefficient of variation

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Table 2Association of pediatric stimulant treatment rates in U.S. counties and county characteristicsa
Table Footer Note

a Treatment prevalence, standardized by age and gender, was calculated as the number of children per 1,000 county residents who had an active prescription on March 15, 2008, and had purchased at least 60 days’ supply of stimulants during the first half of 2008.

Table Footer Note

b R2=.602, df=18, constant=–.497 (.76)

Table Footer Note

c R2=.606, df=21, constant=–.193 (.77)

Table Footer Note

d R2=.641, df=66, constant=–2.062 (.83), p<.05. The coefficients for states are available online as a data supplement to this article.

Table Footer Note

e Mean values for education were imputed for counties with missing data (N=674).

Table Footer Note

*p<.05, **p<.01, ***p<.001

Anchor for Jump
Table 3Association of stimulant treatment rates among adults in U.S. counties and county characteristicsa
Table Footer Note

a Treatment prevalence, standardized by age and gender, was calculated as the number of adults per 1,000 county residents who had an active prescription on March 15, 2008, and had purchased at least 60 days’ supply of stimulants during the first half of 2008.

Table Footer Note

b R2=.606, df=18, constant=–.708 (.14), p<.001

Table Footer Note

c R2=.608, df=21, constant=–.721 (.14), p<.001

Table Footer Note

d R2=.650, df=66, constant=–.432 (.18), p<.01. The coefficients for states are available online as a data supplement to this article.

Table Footer Note

e Mean values for education were imputed for counties with missing data (N=674).

Table Footer Note

*p<.05, **p<.01, ***p<.001

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