Explaining racial and ethnic differences in children's use of stimulant medications
Julie L Hudson1, G Edward Miller, James B Kirby
1Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality/NIH, 540 Gaither Road, Rockville, MD 20850, USA. jhudson@ahrq.gov
Insights
Racial disparities exist in stimulant medication use among US children. Differences in how families and healthcare providers respond to behavioral issues explain some, but not all, of these disparities.
Area of Science:
- Pediatric Health
- Health Disparities
- Pharmacological Interventions
Background:
- Stimulant medications are commonly prescribed for attention-deficit/hyperactivity disorder (ADHD) and other conditions in children.
- Existing literature suggests potential racial and ethnic disparities in the diagnosis and treatment of pediatric behavioral health conditions.
Purpose of the Study:
- To investigate and elucidate racial/ethnic differences in stimulant drug utilization among children in the United States.
- To identify factors contributing to these disparities and understand how they vary across different racial and ethnic groups.
Main Methods:
- Utilized data from a nationally representative sample of children aged 5-17 years from the Medical Expenditure Panel Survey (MEPS) (2000-2002).
- Employed race-specific regressions and Oaxaca-Blinder decomposition to analyze differences in individual/family characteristics and their impact on stimulant use.
- Conducted pooled regressions with race/ethnicity interactions to test for differential responses to mental health and behavioral problems.
Main Results:
- White children were approximately twice as likely to use stimulant medications compared to Hispanic or Black children.
- Individual and family characteristics explained about 25% of the disparity between White and Hispanic children, but none between White and Black children.
- Persistent racial/ethnic gaps in stimulant use were observed even among children with similar reported mental health conditions.
Conclusions:
- The majority of racial/ethnic differences in pediatric stimulant use are attributed to differential responses to individual/family characteristics, underscoring the need for further investigation.
- Significant disparities in stimulant use outcomes exist for children with similar mental health problem reports, suggesting potential influences like discrimination or cultural factors.
Objectives:
To document and explain racial/ethnic differences in the use of stimulant drugs among US children.
Data And Methods:
We use a nationally representative sample of children ages 5-17 years old from the Medical Expenditure Panel Survey (MEPS) for the years 2000-2002. We estimate race-specific means and regressions to highlight differences across groups in individual/family characteristics that may affect stimulant use and differences in responses to these characteristics. Then, we use Oaxaca-Blinder decomposition methods to quantify the portion of differential use explained by differences in individual/family characteristics. Finally, we use pooled regressions with race/ethnicity interactions to formally test the hypothesis that responses to perceived mental health and behavioral problems vary across groups.
Results:
White children are about twice as likely to use stimulants as either Hispanic or Black children. Differences in individual/family characteristics account for about 25% of the difference between whites and Hispanics, but for none of the difference between whites and blacks. Pooled regressions show that racial/ethnic gaps in stimulant use persist among children with otherwise similar reported mental health conditions.
Conclusions:
Our finding that the majority of racial/ethnic differences in children's stimulant use is explained by differences in responses to individual/family characteristics highlights the importance of further research to examine the reasons for these differences. It is striking that children with otherwise similar reports of mental health problems have such different outcomes in terms of stimulant use. Potential explanations range from discrimination to cultural differences by race/ethnicity or community.
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