Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook).
Psychiatr Serv. 2022 Dec 1;73(12):1338-1345. doi: 10.1176/appi.ps.202100578. Epub 2022 Aug 12.
The study examined racial-ethnic disparities in access to and utilization of treatment for attention-deficit hyperactivity disorder (ADHD) and other psychiatric diagnoses among children with ADHD.
Nationally representative, cross-sectional data from the Household Component of the Medical Expenditure Panel Survey 2011-2019 were used to examine racial-ethnic disparities in access to and utilization of treatment by children ages 5-17 with ADHD (N=5,838). Logistic regression models were estimated for access outcomes, and generalized linear models were estimated for utilization outcomes. Multivariable regression models adjusted for race-ethnicity, age, sex, and treatment need in accordance with the Institute of Medicine definition of health care disparities.
In adjusted analyses, compared with White children with ADHD, Black, Hispanic, and Asian children with ADHD had significantly lower rates of any past-year treatment visit for ADHD or for other psychiatric diagnoses. They also had lower rates of having accessed ADHD medication. Compared with White children, Black and Asian children with ADHD used fewer ADHD medications, and Black and Hispanic children with ADHD had lower overall mental health treatment expenditures.
Disparities in ADHD treatment among children from racial-ethnic minority populations may be driven primarily by disparities in access rather than in utilization. Once treatment had been accessed, disparities in utilization were largely accounted for by differences in socioeconomic status. These findings suggest that interventions targeting access to treatment among children from racial-ethnic minority populations may help close existing care gaps.
本研究考察了患有注意力缺陷多动障碍（ADHD）的儿童在获得和接受治疗方面的种族-民族差异，以及 ADHD 及其他精神科诊断的治疗利用情况。
利用 2011-2019 年医疗支出面板调查家庭部分的全国代表性横断面数据，考察了 5-17 岁患有 ADHD 的儿童（N=5838）在获得和接受治疗方面的种族-民族差异。使用逻辑回归模型估计获得治疗的结果，使用广义线性模型估计治疗利用的结果。根据医学研究所定义的医疗保健差异，根据种族-民族、年龄、性别和治疗需求调整多变量回归模型。
在调整后的分析中，与患有 ADHD 的白人儿童相比，患有 ADHD 或其他精神科诊断的黑人、西班牙裔和亚裔儿童接受 ADHD 治疗或任何过去一年治疗的比例明显较低。他们获得 ADHD 药物的比例也较低。与白人儿童相比，患有 ADHD 的黑人和亚裔儿童使用的 ADHD 药物较少，患有 ADHD 的黑人和西班牙裔儿童的整体心理健康治疗支出较低。
少数族裔儿童 ADHD 治疗方面的差异可能主要是由于获得治疗的差异，而不是利用治疗的差异造成的。一旦获得了治疗，利用治疗方面的差异在很大程度上归因于社会经济地位的差异。这些发现表明，针对少数族裔儿童获得治疗的干预措施可能有助于缩小现有护理差距。
