Geographic variation in the prevalence of stimulant medication use among children 5 to 14 years old: Results from a commercially insured US sample
Geographic variation in the prevalence of stimulant medication use among children 5 to 14 years old: Results from a commercially insured US sample
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DOI：
10.1542/peds.111.2.237
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发表时间：
2003-02-01
期刊：
影响因子：
8
通讯作者：
Mager, D
中科院分区：
文献类型：
--
作者：
Cox, ER;Motheral, BR;Mager, D
目标。本研究的目的是评估处方兴奋剂使用流行率的地理差异，以及在全国具有代表性的5至14岁商业保险人群中使用的预测因素。从1999年1月1日到1999年12月31日，对连续符合条件的5至14岁人群的处方索赔活动进行了评估。对每个州的年龄-性别调整患病率进行了估计。使用分层线性模型的多变量逻辑回归来评估年龄、性别、儿童家属数量和国家地区对兴奋剂流行率的影响。城市或农村居住、收入中位数、白人百分比和每10万居民的医生率的背景影响也被控制。在整个研究样本中，兴奋剂治疗的1年患病率为4.2%。多元逻辑回归表明，兴奋剂处方的使用与年龄、男性、较少的儿童依赖性、生活在高收入社区和生活在白人比例较高的社区呈正相关。与生活在美国西部地区的儿童相比，生活在中西部和南部地区的儿童使用至少一种兴奋剂药物的可能性分别是1.55倍（99%置信区间：1.28-1.87）和1.71倍（99%置信区间：1.42-2.06）。还注意到城市和农村居民中兴奋剂流行率的差异。尽管控制了包括年龄和性别在内的重要使用预测因素，但在全国范围内，兴奋剂使用的流行程度存在地理差异。讨论了这种变化的可能原因，并呼吁进行进一步的研究。
Objective. The purpose of this study was to evaluate geographic variation in the prevalence of prescription stimulant use and predictors of use among a nationally representative, commercially insured population 5 to 14 years old.Methods. Prescription claims activity from January 1, 1999 through December 31, 1999 for a continuously eligible population 5 to 14 years old was evaluated. Age-gender adjusted prevalence rates were estimated for each state. Multivariate logistic regression using hierarchical linear modeling was used to evaluate the impact of age, gender, number of child dependents, and region of the country on stimulant prevalence. The contextual effects of urban or rural residence, median income, percent white, and physician rate per 100 000 residents were also controlled for.Results. The 1-year prevalence of stimulant treatment for the entire study sample was 4.2%. Multivariate logistic regression indicated that stimulant prescription use was positively associated with age, male gender, fewer child dependents, living in higher income communities, and living in communities with greater percent white. Compared with children living in the Western region of the country, children living in the Midwest and South were 1.55 (99% confidence interval: 1.28-1.87) and 1.71 (99% confidence interval: 1.42-2.06) times more likely to consume at least 1 stimulant medication, respectively. Differences in stimulant prevalence across urban and rural residence were also noted.Conclusions. Geographic variation in the prevalence of stimulant use exists nationally, despite controlling for important predictors of use including age and gender. Possible reasons for the variation are discussed as are calls for additional research.