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Table 1 Characteristics of children and adolescents with ADHD – Overall and by treatment change cohort

From: Treatment patterns among children and adolescents with attention-deficit/hyperactivity disorder in the United States – a retrospective claims analysis

 

Children

Adolescents

Patient characteristicsa

All patients

No treatment change cohort

Treatment change cohort

Standardized differenceb

All patients

No treatment change cohort

Treatment change cohort

Standardized differenceb

N = 49,756

N = 20,375

N = 29,381

 

N = 29,093

N = 9,377

N = 19,716

 

Demographic characteristicsc

 Age, mean ± SD [median]

8.75 ± 1.92 [9.00]

8.76 ± 1.87 [9.00]

8.74 ± 1.94 [9.00]

0.01

15.02 ± 1.37 [15.00]

14.93 ± 1.37 [15.00]

15.06 ± 1.37 [15.00]

0.10

 Female, N (%)

15,332 (30.8)

6,215 (30.5)

9,117 (31.0)

0.01

11,078 (38.1)

3,494 (37.3)

7,584 (38.5)

0.02

 Health plan type, N (%)

  Preferred provider organization

28,267 (56.8)

11,646 (57.2)

16,621 (56.6)

0.01

16,328 (56.1)

5,351 (57.1)

10,977 (55.7)

0.03

  Consumer driven health plan

7,095 (14.3)

2,978 (14.6)

4,117 (14.0)

0.02

4,063 (14.0)

1,355 (14.5)

2,708 (13.7)

0.02

  Home maintenance organization

5,577 (11.2)

2,278 (11.2)

3,299 (11.2)

0.00

3,304 (11.4)

1,028 (11.0)

2,276 (11.5)

0.02

  High deductible health plan

4,304 (8.7)

1,598 (7.8)

2,706 (9.2)

0.05

2,580 (8.9)

781 (8.3)

1,799 (9.1)

0.03

  Point of service, no capitation

2,790 (5.6)

1,191 (5.8)

1,599 (5.4)

0.02

1,667 (5.7)

522 (5.6)

1,145 (5.8)

0.01

  Comprehensive

1,096 (2.2)

424 (2.1)

672 (2.3)

0.01

777 (2.7)

231 (2.5)

546 (2.8)

0.02

  Exclusive provider organization

349 (0.7)

137 (0.7)

212 (0.7)

0.01

232 (0.8)

66 (0.7)

166 (0.8)

0.02

  Point of service, partially or fully capitated

181 (0.4)

78 (0.4)

103 (0.4)

0.01

91 (0.3)

33 (0.4)

58 (0.3)

0.01

  Unknown

97 (0.2)

45 (0.2)

52 (0.2)

0.01

51 (0.2)

10 (0.1)

41 (0.2)

0.03

 Region of residence, N (%)

  South

26,036 (52.3)

11,160 (54.8)

14,876 (50.6)

0.08

26,036 (52.3)

4,698 (50.1)

9,333 (47.3)

0.06

  North central

10,753 (21.6)

4,382 (21.5)

6,371 (21.7)

0.00

10,753 (21.6)

2,205 (23.5)

4,527 (23.0)

0.01

  West

6,911 (13.9)

2,622 (12.9)

4,289 (14.6)

0.05

6,911 (13.9)

1,314 (14.0)

2,964 (15.0)

0.03

  Northeast

5,984 (12.0)

2,182 (10.7)

3,802 (12.9)

0.07

5,984 (12.0)

1,140 (12.2)

2,858 (14.5)

0.07

  Unknown

72 (0.1)

29 (0.1)

43 (0.1)

0.00

72 (0.1)

20 (0.2)

34 (0.2)

0.01

Clinical characteristicsd

 Type of ADHD diagnosise, N (%)

  Inattentive

21,820 (43.9)

8,674 (42.6)

13,146 (44.7)

0.04

10,851 (37.3)

3,348 (35.7)

7,503 (38.1)

0.05

  Hyperactive

15,317 (30.8)

6,646 (32.6)

8,671 (29.5)

0.07

13,706 (47.1)

4,639 (49.5)

9,067 (46.0)

0.07

  Combined

8,511 (17.1)

3,362 (16.5)

5,149 (17.5)

0.03

2,397 (8.2)

739 (7.9)

1,658 (8.4)

0.02

  Other/unspecified

4,107 (8.3)

1,693 (8.3)

2,414 (8.2)

0.00

2,137 (7.3)

651 (6.9)

1,486 (7.5)

0.02

  Unknown

1 (0.0)

0 (0.0)

1 (0.0)

0.01

2 (0.0)

0 (0.0)

2 (0.0)

0.01

 Comorbidities associated with ADHD f,g, N (%)

  Acute upper respiratory infections

13,105 (26.3)

5,144 (25.2)

7,961 (27.1)

0.04

6,613 (22.7)

2,103 (22.4)

4,510 (22.9)

0.01

  Acute pharyngitis

7,701 (15.5)

3,071 (15.1)

4,630 (15.8)

0.02

3,746 (12.9)

1,213 (12.9)

2,533 (12.8)

0.00

  Depression

5,513 (11.1)

2,062 (10.1)

3,451 (11.7)

0.05

6,496 (22.3)

1,789 (19.1)

4,707 (23.9)

0.12

  Anxiety disorders

5,473 (11.0)

1,853 (9.1)

3,620 (12.3)

0.10

5,161 (17.7)

722 (7.7)

1,498 (7.6)

0.00

 Prior use of other pharmacological treatments

  Penicillins

8,465 (17.0)

3,349 (16.4)

5,116 (17.4)

0.03

3,605 (12.4)

1,184 (12.6)

2,421 (12.3)

0.01

  Antiasthmatic and bronchodilator agents

5,959 (12.0)

2,356 (11.6)

3,603 (12.3)

0.02

2,801 (9.6)

905 (9.7)

1,896 (9.6)

0.00

  Dermatologicals

3,967 (8.0)

1,546 (7.6)

2,421 (8.2)

0.02

4,532 (15.6)

1,427 (15.2)

3,105 (15.7)

0.01

  Cephalosporins

3,801 (7.6)

1,486 (7.3)

2,315 (7.9)

0.02

1,795 (6.2)

555 (5.9)

1,240 (6.3)

0.02

  Macrolides

3,520 (7.1)

1,341 (6.6)

2,179 (7.4)

0.03

2,360 (8.1)

745 (7.9)

1,615 (8.2)

0.01

  Nasal agents—systemic and topical

2,902 (5.8)

1,143 (5.6)

1,759 (6.0)

0.02

1,599 (5.5)

536 (5.7)

1,063 (5.4)

0.01

  Corticosteroids

2,832 (5.7)

1,148 (5.6)

1,684 (5.7)

0.00

1,770 (6.1)

546 (5.8)

1,224 (6.2)

0.02

  Antidepressants

2,761 (5.5)

878 (4.3)

1,883 (6.4)

0.09

4,829 (16.6)

1,426 (15.2)

3,403 (17.3)

0.06

  1. ADHD Attention-deficit/hyperactivity disorder, SD Standard deviation
  2. a Patient characteristics were reported for all patients included in the study. Results were stratified by children and adolescents with ADHD and by treatment change cohort (i.e., no treatment change cohort, including patients who did not have a treatment change observed during the 12-month study period [i.e., remained on the first treatment regimen observed]; and treatment change cohort, including patients who had ≥ 1 treatment change observed during the 12-month study period)
  3. b The absolute standardized difference is reported as the difference between the no treatment change cohort and treatment change cohort. A standardized difference of greater than 0.1 was considered to be an important difference
  4. c Demographic characteristics were measured as of the index date, defined as the first observed ADHD-related treatment that was preceded by 6 months of no ADHD-related treatments observed in pharmacy claims. Characteristics were reported for the first 3 treatment regimens of selected ADHD-related agents observed in pharmacy claims. Treatment sequences of treatment regimens observed during the 12-month study period (i.e., the 12-month period following the index date) were defined as all ADHD-related agents observed within 30 days of the first ADHD-related agent and were identified using prescription fills during the 18-month follow-up period (i.e., the 18-month period following the index date)
  5. d Clinical characteristics were reported during the baseline period, defined as the 6-month period prior to the index date. The index date was defined as the first observed ADHD-related treatment that was preceded by 6 months of no ADHD-related treatments observed in pharmacy claims
  6. e The prevalence of combined ADHD was likely an underestimation as data on the diagnosis of combined ADHD was only available from October 2015 when ICD-10-CM codes were implemented
  7. f Based on Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., & Spencer, T. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of psychiatry, 163(4), 716–723
  8. g Based on American Psychiatric Pub (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) and Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J. C & Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care, 43(11), 1130–1139
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BMC Psychiatry

ISSN: 1471-244X

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