Hispanic residential isolation, ADHD diagnosis and stimulant treatment among Medicaid-insured youth

Dinci Pennap, Mehmet Burcu, Daniel J. Safer, Julie M. Zito

Research output: Contribution to journalArticle

Abstract

Objective: This study aimed to evaluate a conceptual framework that assessed the effect of Hispanic residential isolation on Attention Deficit Hyperactivity Disorder (ADHD) health service utilization among 2.2 million publicly insured youth. Design: Cross-sectional. Setting: Medicaid administrative claims data for ambulatory care services from a US Pacific state linked with US census data. Participants: Youth, aged 2-17 years, continuously enrolled in 2009. Main Outcome Measures: The percent annual prevalence and odds of ADHD diagnosis and stimulant use according to two measures of racial/ethnic residential isolation: 1) the county-level Hispanic isolation index (HI) defined as the population density of Hispanic residents in relation to other racial/ethnic groups in a county (<.5; .5-.64; ≥.65); and 2) the proportion of Hispanic residents in a ZIP code tabulation area (<25%; 25%-50%; >50%). Results: Among the 47,364 youth with a clinician-reported ADHD diagnosis, 60% received a stimulant treatment (N = 28,334). As the county level HI increased, Hispanic residents of ethnically isolated locales were significantly less likely to receive an ADHD diagnosis (adjusted odds ratio [AOR]=.92 [95% CI=.88-.96]) and stimulant use (AOR=.61 [95% CI=.59-.64]) compared with Hispanic youth in less isolated areas. At the ZIP code level, a similar pattern of reduced ADHD diagnosis (AOR=.81 [95% CI=.77-.86]) and reduced stimulant use (AOR=.65 [95% CI=.61-.69]) was observed as Hispanic residential isolation increased from the least isolated to the most isolated ZIP code areas. Conclusions: These findings highlight the opportunity for Big Data to advance mental health research on strategies to reduce racial/ethnic health disparities, particularly for poor and vulnerable youth. Further exploration of racial/ethnic residential isolation in other large data sources is needed to guide future policy development and to target culturally sensitive interventions.

Original languageEnglish (US)
Pages (from-to)85-94
Number of pages10
JournalEthnicity and Disease
Volume27
Issue number2
DOIs
StatePublished - Mar 1 2017

Fingerprint

Medicaid
Attention Deficit Disorder with Hyperactivity
Hispanic Americans
Odds Ratio
Therapeutics
Pacific States
Policy Making
Information Storage and Retrieval
Censuses
Ambulatory Care
Population Density
Ethnic Groups
Health Services
Mental Health
Outcome Assessment (Health Care)
Health
Research

Keywords

  • ADHD
  • Hispanic youth
  • Medicaid
  • Racial/ethnic disparities
  • Residential segregation
  • Stimulants

ASJC Scopus subject areas

  • Epidemiology
  • Medicine(all)

Cite this

Hispanic residential isolation, ADHD diagnosis and stimulant treatment among Medicaid-insured youth. / Pennap, Dinci; Burcu, Mehmet; Safer, Daniel J.; Zito, Julie M.

In: Ethnicity and Disease, Vol. 27, No. 2, 01.03.2017, p. 85-94.

Research output: Contribution to journalArticle

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