Racial disparity in psychotropic medications prescribed for Medicaid-insured youth: A ten-year trend

Introduction: Over the past 20 years, there has been a substantial increase in the prevalence of psychotropic medications prescribed for the treatment of behavioral and emotional problems in youth. Despite the increased use in psychotropic medications in U.S. youth, African American and Hispanic youth are significantly less likely to be dispensed psychotropic medications than white youth1. More recently, parent-reported data from Medical Expenditures Panel Surveys (MEPS) suggested a narrowing of the white:African American stimulant ratio in 1996 compared to 1987 2. Also, Zito et al. (2003), showed a slight narrowing of the disparity. Additional analyses are needed to clarify trends in racial disparities for psychotropic medication in youth.

Methods: The data source was prescription claims from a mid-Atlantic state Medicaid program for the years 1997, 2001, and 2006. The dataset comprised youth less than 20 years of age on January 1st of the study years who were enrolled in the Medicaid program for at least 10 months of continuous eligibility. Psychotropic medications included the following classes: stimulants, antipsychotics, antidepressants, anticonvulsant-mood stabilizers, lithium, alpha agonists, and anxiolytics/sedative hypnotics. Logistic regression modeling used year (2006 and 1997) and race/ethnicity (White, African American, Hispanic, Unknown, and Other) as grouping variables and psychotropic medication use as the dependent variable and adjusted for age group, gender, and eligibility category. Results: The population of Medicaid-eligible youth less than 20 years of age grew from 208,950 in 1997 to 371,819 in 2006. Hispanic enrollees were 3.75 times more common and youth eligible for SCHIP rose 3-fold (13.9%-41.9%) from 1997 to 2006. The annual prevalence of psychotropic medication use in 2006 was 11% (n=40,768). For the ten-year period, white youth were significantly more likely than African American youth to be dispensed a psychotropic medication (OR 2.58, CI=2.53, 2.64. The rank order of psychotropic medication class use was: stimulants (6.3%), anxiolytic/hypnotic sedatives (3.0%), and antidepressants (2.6%). Conclusion: Race/ethnicity continues to play an important role in explaining psychotropic medication patterns in Medicaid-enrolled youth. Access is an unlikely barrier to lower psychotropic use among non-whites and cultural issues should be explored.