Health Systems and Services Research
Health Systems and Services Research
Many children in underserved communities face food insecurity, which can adversely impact behavioral disorders. The National Institute of Mental Health-funded study uses medical claims data linked to educational outcomes for Arkansas public schoolchildren to test whether school meal delivery options that make it easier to participate in child nutrition programs lead to improvements in discipline and academic performance at school. The study will also determine whether school meal delivery policies can reduce the diagnosis of behavioral disorders and associated healthcare utilization.
In the United States, Arkansas ranks second highest for the percentage of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Oppositional defiant disorder (ODD) and conduct disorder (CD) are common comorbidities of ADHD. These three behavioral disorders have significant public health impacts as they impede the social, emotional, and personal development of children and adolescents. This study described geographic variation in the prevalence of behavioral disorders among children and adolescents in Arkansas. I used a retrospective cross-sectional design aggregating the prevalence of behavioral disorders at the ZIP-code level in the Arkansas All-Payer Claims Database (APCD). ZIP codes were grouped into quintiles based on the prevalence of behavioral disorders among the children and adolescent population. ZIP codes in quintile 1 (Q1) had the lowest prevalence of behavioral disorders, whereas those in quintile 5 (Q5) had the highest. Population characteristics and medical claims data from Arkansas APCD 2019 were linked to Child Opportunity Index 2.0 ZIP-code neighborhood characteristic data.
Findings indicated that there was substantial variation in rates of behavioral disorders prevalence across ZIP-code aggregated quintiles (Q1: 5.0%; Q2: 7.1%; Q3: 8.6%; Q4: 10.1%; Q5: 13.1%), with a coefficient of variation of 31.7% and a 90th-to-10th-percentile prevalence ratio of 2.4. By geographic region, North-East Arkansas had the highest concentration of high-prevalence ZIP codes, whereas North-West Arkansas had higher concentrations of low- prevalence ZIP codes.
Among children and adolescents all over the US including Arkansas, ADHD, ODD, and CD are common behavioral disorders. These behavioral disorders have significant public health impacts as they impede the social, emotional, and personal development of children and adolescents that can carry forward into adulthood, and have negative health and financial implications. This study aimed to estimate the updated prevalence of ADHD, ODD, and CD and evaluate the prevalence trends from 2013 to 2019 among Arkansas children and adolescents utilizing the All-Payer Claims Database (APCD).
Findings highlighted that among the 456,929 children and adolescents aged 4-17 years in 2019 in Arkansas, the prevalence estimates of ADHD, ODD, CD, and any behavioral disorders were 11.2% (95% CI, 11.1-11.3), 2.4% (95% CI, 2.3-2.4), 4.3% (95% CI, 4.25-4.4), and 13.5% (95% CI, 13.4-13.6) respectively. Across all these behavioral disorders there were statistically significant differences (p<.0001) in the prevalence according to sex, age, and insurance coverage. From 2013 to 2019 there was an upward though insignificant trend in ADHD prevalence (10.7% in 2013 to 11.2% in 2019), a downward significant trend in both ODD (3.6% in 2013 to 2.4% in 2019) and CD (5% in 2013 to 4.3% in 2019) prevalence.