County level disparities in the prescription of antipsychotic drugs among children on Medicaid in Wisconsin

OBJECTIVE: To identify disparities in the use of antipsychotic drugs among children who receive Medicaid in Wisconsin. METHODS: Study population included all children ages 0 to 18 in Wisconsin who were insured by Medicaid or were in foster care between 2008 and 2011 (n=439,567), including 13,187 children who received at least one antipsychotic fill. To identify disparities in prescribing practices, we used GIS mapping and multilevel modeling to explore the effects of county level demographic and economic characteristics, disease prevalence rates, and access to quality health care on antipsychotic prescription among children. RESULTS: GIS mapping shows that disparities exist in the number of children who were prescribed antipsychotics by geographic area. Children in foster care were more likely to be medicated, to be medicated for longer, and to experience polypharmacy than other children who received Medicaid. Children living in counties with higher median income (OR=.95, 95% CI: .92-.97) and higher rates of uninsured (OR=.84, 95% CI: .72-.98) are less likely to receive antipsychotics. We did not find relationships between quality of care, rates of adult disease, or rates of medical providers and child antipsychotic prescribing after controlling for median income. CONCLUSIONS: In Wisconsin, disparities in antipsychotic prescribing are not only racial, but also geographic and socio-economic. These disparities raise questions about prescribing practices, the impact of poverty on mental health, and the medicalization of poverty. Disparities in antipsychotic prescribing among children may lead to disparities in adult health, as antipsychotics have been associated with long-term negative health consequences.