Racial and Ethnic Differences in Antipsychotic Medication Use Among Children Enrolled in Medicaid

Abstract

OBJECTIVE: The objective of this study was to detect and measure differences in antipsychotic drug use across racial-ethnic groups of children enrolled in Medicaid. METHODS: The main data sources were the Medicaid MAX Person Summary and the MAX Prescription Drug files for calendar years 2005-2009 and the Environmental Scanning and Program Characteristics Database. The analyses were based on the entire population (5.8 million) of Medicaid-enrolled children and adolescents, ages two to 20, from eight states. Proportional hazard and ordinary least-squares multivariate regressions were used to assess the effect of race-ethnicity on the likelihood of antipsychotic prescription fills and the use of any psychiatric services. RESULTS: The study found robust and statistically significant evidence of higher antipsychotic drug use among white children, especially relative to Hispanic and Asian children. When analyses held all variables constant, the probability of having an antipsychotic fill was lower compared with whites by 1.8 percentage points for African Americans, by 2.0 percentage points for Asians, and by 1.8 percentage points for Hispanics. These effects are large in light of the finding that the probability of an antipsychotic prescription fill across child-years was only 2.4%. Children from these minority groups were also less likely to receive psychiatric services. CONCLUSIONS: Substantial racial-ethnic differences were found in antipsychotic use. Explanations based on greater aversion to pharmacological treatment among minority groups are insufficient to explain the phenomenon.