In the Journals

Racial, ethnic disparities persist in ADHD diagnosis

Michael P. Milham

Racial and ethnic inequalities in rates of ADHD diagnosis remain despite overall increasing prevalence and incidence of adults diagnosed, according to results published in JAMA Network Open.

“Racial and ethnic disparities in the seeking and delivery of care for ADHD in adults remain prominent, putting a substantial portion of the population at increased risk for the many negative outcomes associated with ADHD,” Michael P. Milham, MD, PhD, of the Nathan S. Kline Institute for Psychiatric Research in New York, told Healio Psychiatry.

According to Milham and colleagues, research into differences in diagnostic trends for ADHD among a broad range of racial/ethnic groups is lacking. The researchers evaluated electronic medical records from Kaiser Permanente Northern California between 2007 and 2016 to address this research gap. They investigated trends in the diagnosis of ADHD for 5,282,877 adults and 867,453 children aged 5 years to 11 years. Patients identified as African American or black, Native American, Pacific Islander, Latino or Hispanic, non-Hispanic white, Asian American or other.

Of the adult patients, 59,371 (1.2%) were diagnosed with ADHD, and prevalence increased from 0.43% in 2007 to 0.96% in 2016. Of the pediatric patients, prevalence increased from 2.96% in 2007 to 3.74% in 2016. The researchers observed that annual adult ADHD prevalence increased for every race/ethnicity during the study period. Notably, white individuals consistently had the highest prevalence rates (0.67% to 1.42%). Prevalence rates were 0.22% to 0.69% for black individuals, 0.56% to 1.14% for Native American individuals, 0.11% to 0.39% for Pacific Islander individuals, 0.25% to 0.65% for Hispanic or Latino individuals, 0.11% to 0.35% for Asian American individuals and 0.29% to 0.71% for individuals from other races/ethnicities. Several factors were positively associated with odds of ADHD diagnosis — younger age, male sex, white race, being divorced, being employed and having a higher education level. The researchers considered the presence of other psychiatric diagnoses a “major factor associated with likelihood of adult ADHD diagnosis,” they wrote. Further, adults with ADHD had significantly higher odds of STIs (OR = 1.289; 95% CI, 1.251-1.329) and frequent health care utilization (OR = 1.303; 95% CI, 1.272-1.334).

Although the exact reasons for racial/ethnic differences in ADHD diagnoses remain unclear, the researchers noted that there should be an increased focus on unbiased documentation of symptoms across development, as well as a greater emphasis on cultural influences on health care seeking and delivery.

“I was encouraged by the fact that the recognition of ADHD in adults is increasing and disparities decreasing, though alarmed by the substantial work still needed to remove diagnostic disparities,” Milham said. “Increased research into the factors driving these disparities, and attention by clinicians on the front lines, are essential to correcting these trends.” – by Joe Gramigna

Disclosures: Milham reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Michael P. Milham

Racial and ethnic inequalities in rates of ADHD diagnosis remain despite overall increasing prevalence and incidence of adults diagnosed, according to results published in JAMA Network Open.

“Racial and ethnic disparities in the seeking and delivery of care for ADHD in adults remain prominent, putting a substantial portion of the population at increased risk for the many negative outcomes associated with ADHD,” Michael P. Milham, MD, PhD, of the Nathan S. Kline Institute for Psychiatric Research in New York, told Healio Psychiatry.

According to Milham and colleagues, research into differences in diagnostic trends for ADHD among a broad range of racial/ethnic groups is lacking. The researchers evaluated electronic medical records from Kaiser Permanente Northern California between 2007 and 2016 to address this research gap. They investigated trends in the diagnosis of ADHD for 5,282,877 adults and 867,453 children aged 5 years to 11 years. Patients identified as African American or black, Native American, Pacific Islander, Latino or Hispanic, non-Hispanic white, Asian American or other.

Of the adult patients, 59,371 (1.2%) were diagnosed with ADHD, and prevalence increased from 0.43% in 2007 to 0.96% in 2016. Of the pediatric patients, prevalence increased from 2.96% in 2007 to 3.74% in 2016. The researchers observed that annual adult ADHD prevalence increased for every race/ethnicity during the study period. Notably, white individuals consistently had the highest prevalence rates (0.67% to 1.42%). Prevalence rates were 0.22% to 0.69% for black individuals, 0.56% to 1.14% for Native American individuals, 0.11% to 0.39% for Pacific Islander individuals, 0.25% to 0.65% for Hispanic or Latino individuals, 0.11% to 0.35% for Asian American individuals and 0.29% to 0.71% for individuals from other races/ethnicities. Several factors were positively associated with odds of ADHD diagnosis — younger age, male sex, white race, being divorced, being employed and having a higher education level. The researchers considered the presence of other psychiatric diagnoses a “major factor associated with likelihood of adult ADHD diagnosis,” they wrote. Further, adults with ADHD had significantly higher odds of STIs (OR = 1.289; 95% CI, 1.251-1.329) and frequent health care utilization (OR = 1.303; 95% CI, 1.272-1.334).

Although the exact reasons for racial/ethnic differences in ADHD diagnoses remain unclear, the researchers noted that there should be an increased focus on unbiased documentation of symptoms across development, as well as a greater emphasis on cultural influences on health care seeking and delivery.

“I was encouraged by the fact that the recognition of ADHD in adults is increasing and disparities decreasing, though alarmed by the substantial work still needed to remove diagnostic disparities,” Milham said. “Increased research into the factors driving these disparities, and attention by clinicians on the front lines, are essential to correcting these trends.” – by Joe Gramigna

Disclosures: Milham reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.