Factors associated with sustained release psychostimulant prescriptions for pediatric ADHD
Background: Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder characterized by functional impairment due to symptoms of inattention, impulsivity, and hyperactivity. Psychostimulant medications effectively reduce these symptoms, however there is little evidence regarding the factors associated with use of different types of stimulant medications. Objective: To investigate factors associated with sustained release (SR) and immediate release (IR) stimulant prescription for pediatric ADHD.^ Methodology: A cross-sectional observational study was conducted using the 2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of physician office visits. Independent predictors of SR stimulant medication prescription, as compared to IR stimulant prescription, were identified from logistic regression models.^ Results: Our data set contained visits representative of 928,629,953 office visits from 2012, of which 105,548,504 visits had an associated age of 4-17 years old (11.39%). Of these pediatric visits, there were 7,088,227 visits (7.56%) with an ADHD diagnosis code (ICD-9: 314.00, 314.01). Of this childhood ADHD population, the majority of visits were male (n=5,155,695, 72.74%). The most frequent age groups were 7 to 11 years (N=3,374,121, 47.60%) and 12-17 years (N=46,097, 42.97%), while the 4-6 year age group was less frequent (N=668,010, 9.42%). The most frequent race was white (n=4,771,295, 67.31%), while less frequent were black race (N=1,229,675, 17.35%) and Hispanic race (N=956,710, 13.50%).The most frequent office region was the South (n=3,221,211, 45.44%) and the least frequent was the Northeast (n=912,679, 12.88%). Finally, the most frequent pay type for visits was private insurance (N=3,427,928, 48.36%) and Medicaid (N=2,473,735, 34.90%).^ After applying our study inclusion criteria, which excluded visits with age below 4 or above 17 and excluded those with non-stimulants, there were 4,617,709 pediatric visits with IR or SR prescriptions. Of this study sample, 3,431,741 mentioned sustained release stimulant (74.35%) and 1,185,968 visits mentioned immediate release stimulant (25.68%). There were 1,969,116 visits with a combination of SR/IR (42.64%), which we included as SR in our comparative analysis.^ Our initial logistic modeling approach identified a number of sociodemographic predictors of SR prescription, relative to IR prescription. Compared with the 4-6 year old age group, the middle and older groups were more likely to have a SR prescription ([7-11 vs. 4-6 odds ratio OR=1.695, (0.672, 4.249)], [12-17 vs. 4-6 OR = 2.741 (1.005, 7.475]). Compared to other regions, visits in the West region were less likely to have an SR prescription (OR=0.457, [0.153, 1.37]) and, relative to white children, those of "Non-Hispanic Other" race were more likely to have SR drug mention (OR=6.186 [1.106, 34.607]). Interestingly, this approach failed to find many significant relationships between sociodemographic factors and ADHD healthcare disparities previously identified in the literature. After our initial model was constructed, we created a reduced model with the two most significant predictors: autism and anxiety disorder. Regarding these ADHD comorbidities, we found that those visits with a diagnosis of autism were less likely to receive a SR medication (OR=0.012, [0.001, 0.134]). Visits with a comorbid diagnosis of an anxiety disorder were much more likely to have a mention of SR stimulants (OR= 3.269 [1.193, 8.955]) as compared to visits not having such diagnoses. Conclusions: In this nationally representative sample of pediatric physician office visits, visits of adolescent age or those with both ADHD and anxiety disorder had a higher likelihood of a SR stimulant drug mention than an IR mention. In contrast, visits with a diagnosis of autism and those in the Western region were more likely to have only an IR stimulant prescription. We did not find evidence to support disparities in SR use in Black or Hispanic children. These cross-sectional data document sociodemographic differences that may be helpful for identifying office visits with a predisposition towards SR or IR stimulant use and to further understand the choice of ADHD drug for childhood ADHD. ^
"Factors associated with sustained release psychostimulant prescriptions for pediatric ADHD"
Dissertations and Master's Theses (Campus Access).