Stimulant Patterns, Alone or with Other Psychotropic Classes, in Medicaid-Insured Youth Continuously Enrolled for 3-8 Years

Authors

Daniel Zhu, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Julie M. Zito, Department of Practice, Sciences and Health Outcomes Research, University of Maryland, Baltimore, Baltimore, Maryland, USA.
James F. Gardner, Department of Practice, Sciences and Health Outcomes Research, University of Maryland, Baltimore, Baltimore, Maryland, USA.
Heather A. Young, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Scott Quinlan, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
Angelo Elmi, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

2-16-2024

Journal

Journal of child and adolescent psychopharmacology

DOI

10.1089/cap.2023.0028

Keywords

Medicaid; children and adolescents; long-term use; polypharmacy

Abstract

Little U.S. pharmacoepidemiologic study is based on treatment during continuous enrollment for periods more than a year. This study aims to show pediatric patterns of stimulant use (alone or with other psychotropic classes) from Medicaid administrative claims data for stimulant patterns of 3- to 8-year continuous enrollees. A retrospective cohort study was derived from Medicaid enrollment, pharmacy, and diagnosis claims data (2007-2014) in a mid-Atlantic state. Youth aged 2-17 years with 3-8 years of continuous enrollment treated with stimulants were compared with a date-matched comparison group treated without stimulants. Major outcomes include prevalence and duration of stimulant use and patterns of stimulant polypharmacy across relatively long enrollments (3-8 years). Among 264,518 unique 2- to 17-year olds with 3-8 years of continuous enrollment, 16.5% had stimulant prescription dispensings, doubling the annual national prevalence of 8.1%. Subgroup analysis showed that the highest prevalence of stimulant use was for 6- to 11-year olds (20.4%), foster care eligible youth (42.3%), and those with 7-8 years of continuous enrollment (20.1%). Externalizing psychiatric disorders were far more common in those treated with stimulants than in those treated without stimulants. The duration of stimulant exposure overall was a median of 487 days, half that of foster care stimulant users. Stimulant polypharmacy with two or more psychotropic classes concomitantly characterized 29.8% of stimulant users. Among those with three or four or more class polypharmacy, 85% and 88%, respectively, had concomitant stimulant and antipsychotic use. The adjusted odds ratio (AOR) of three or more class polypharmacy significantly increased in 12- to 17-year-old age group (AOR = 1.8), foster care eligibility (AOR = 4.5), and among those with the longest enrollment (AOR = 1.7). Stimulant prevalence in Medicaid-insured youth with continuous enrollment of 3-8 years was twice as common as in annual data sets. Future research should investigate three to five interclass stimulant polypharmacy effectiveness in reliably diagnosed community populations.

APA Citation

Zhu, Daniel; Zito, Julie M.; Gardner, James F.; Young, Heather A.; Quinlan, Scott; and Elmi, Angelo, "Stimulant Patterns, Alone or with Other Psychotropic Classes, in Medicaid-Insured Youth Continuously Enrolled for 3-8 Years" (2024). GW Authored Works. Paper 4337.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4337

Department

Epidemiology