Rubin David M, Feudtner Chris, Localio Russell, Mandell David S
Division of General Pediatrics, Children's Hospital of Philadelphia, PolicyLab, Center to Bridge Research, Practice, and Policy,Safe Place, Philadelphia, Pennsylvania 19104, USA.
Pediatrics. 2009 Aug;124(2):e305-12. doi: 10.1542/peds.2008-3713. Epub 2009 Jul 20.
The objective of this study was to compare on a national cohort of children with autism spectrum disorder (ASD) the concurrent use of >or=3 psychotropic medications between children in foster care and children who have disabilities and receive Supplemental Security Income, and to describe variation among states in the use of these medications by children in foster care.
Studied was the concurrent use of >or=3 classes of psychotropic medications, identified from the 2001 Medicaid claims of 43406 children who were aged 3 to 18 years and had >or=1 annual claim for ASD. Medicaid enrollment as a child in foster care versus a child with disabilities was compared. Multilevel logistic regression, clustered at the state level and controlling for demographics and comorbidities, yielded standardized (adjusted) estimates of concurrent use of >or=3 medications and estimated variation in medication use within states that exceeded 1 and 2 SDs from the average across states.
Among children in foster care, 20.8% used >or=3 classes of medication concurrently, compared with 10.1% of children who were classified as having a disability. Differences grew in relationship to overall use of medications within a state; for every 5% increase in concurrent use of >or=3 medication classes by a state's population with disabilities, such use by children in a state's foster care population increased by 8.3%. Forty-three percent (22) of states were >1 SD from the adjusted mean for children who were using >or=3 medications concurrently, and 14% (7) of the states exceeded 2 SDs.
Among children with ASD, children in foster care were more likely to use >or=3 medications concurrently than children with disabilities. State-level differences underscore policy or programmatic differences that might affect the receipt of medications in this population.
本研究的目的是在全国自闭症谱系障碍（ASD）儿童队列中，比较寄养儿童与残疾儿童且领取补充保障收入者同时使用≥3种精神药物的情况，并描述各州寄养儿童使用这些药物的差异。
研究对象为2001年医疗补助申请记录中年龄在3至18岁且有≥1次ASD年度申请记录的43406名儿童，确定其同时使用≥3类精神药物的情况。比较儿童作为寄养儿童与残疾儿童的医疗补助登记情况。采用在州层面聚类并控制人口统计学和共病情况的多水平逻辑回归，得出同时使用≥3种药物的标准化（调整后）估计值以及各州内药物使用情况相对于各州平均水平超过1和2个标准差的估计差异。
在寄养儿童中，20.8%的儿童同时使用≥3类药物，而被归类为残疾的儿童这一比例为10.1%。这种差异与一个州内药物的总体使用情况相关；一个州残疾人群体中同时使用≥3类药物的比例每增加5%，该州寄养儿童群体中此类药物的使用比例就增加8.3%。43%（22个）的州同时使用≥3种药物的儿童比例偏离调整后均值超过1个标准差，14%（7个）州超过2个标准差。
在患有ASD的儿童中，寄养儿童比残疾儿童更有可能同时使用≥3种药物。州层面的差异凸显了可能影响该人群药物获取的政策或项目差异。
