Exhibit 4.
Characteristics and mental health diagnoses (hierarchical classification) in children enrolled in Medicaid with antipsychotic use in 2008, 2013, 2016
| Children with antipsychotic use |
||||||
|---|---|---|---|---|---|---|
| Patient characteristic | 2008 N=348,253 |
2013 N=395,424 |
2016 N=323,861 |
|||
| No. | % | No. | % | No. | % | |
| Female | 104,142 | 29.9 | 122,830 | 31.1 | 106,435 | 32.9 |
| Age, median (IQR) | 12 (9–15) | 12 (9–15) | 13 (10–15) | |||
| 2–5 years | 15,176 | 4.4 | 12,229 | 3.1 | 6,748 | 2.1 |
| 6–12 years | 165,879 | 47.6 | 187,766 | 47.5 | 147,651 | 45.6 |
| 13–17 years | 167,198 | 48.0 | 195,429 | 49.4 | 169,462 | 52.3 |
| Race, ethnicity | ||||||
| White, non-Hispanic | 192,587 | 55.3 | 200,169 | 50.6 | 144,839 | 44.7 |
| Black, non-Hispanic | 73,991 | 21.2 | 77,490 | 19.6 | 53,498 | 16.5 |
| Hispanic | 37,563 | 10.8 | 44,939 | 11.4 | 42,985 | 13.3 |
| Asian, non-Hispanic | 1,370 | 0.4 | 1,851 | 0.5 | 2,328 | 0.7 |
| Other non-Hispanic | 5,827 | 1.7 | 9,839 | 2.5 | 4,628 | 1.4 |
| Unknown | 36,915 | 10.6 | 61,136 | 15.5 | 75,583 | 23.3 |
| Any diagnosis associated with an FDA approved indication (1+ drug in class, any age <18) | 133,378 | 38.3 | 160,237 | 40.5 | 145,569 | 44.9 |
| Hierarchical classification (mutually exclusive groups)a | ||||||
| Schizophrenia, psychotic-related disorders | 18,995 | 5.5 | 29,711 | 7.5 | 26,663 | 8.2 |
| Pervasive developmental disorder; Intellectual disabilities | 49,880 | 14.3 | 73,327 | 18.5 | 74,419 | 23.0 |
| Bipolar disorder | 62,086 | 17.8 | 54,123 | 13.7 | 41,808 | 12.9 |
| Tic disorder | 2,417 | 0.7 | 3,076 | 0.8 | 2,679 | 0.8 |
| Conduct, disruptive behavior disorder, without ADHD | 23,448 | 6.7 | 24,480 | 6.2 | 15,856 | 4.9 |
| Conduct, disruptive behavior disorder, with comorbid ADHD | 43,011 | 12.4 | 61,800 | 15.6 | 50,312 | 15.5 |
| ADHD | 79,733 | 22.9 | 88,593 | 22.4 | 65,706 | 20.3 |
| Depression | 11,923 | 3.4 | 14,668 | 3.7 | 15,848 | 4.9 |
| PSTD | 3,318 | 1.0 | 3,432 | 0.9 | 2,980 | 0.9 |
| Anxiety disorder or obsessive-compulsive disorder | 2,956 | 0.8 | 4,078 | 1.0 | 3,993 | 1.2 |
| Adjustment-related disorders | 3,674 | 1.1 | 2,900 | 0.7 | 1,856 | 0.6 |
| Other/unspecified mood disorder | 4,638 | 1.3 | 7,251 | 1.8 | 3,963 | 1.2 |
| Sleep disorder | 887 | 0.3 | 886 | 0.2 | 729 | 0.2 |
| Other mental health diagnosis | 5,865 | 1.7 | 4,985 | 1.3 | 4,146 | 1.3 |
| No mental health diagnosis | 35,422 | 10.2 | 22,114 | 5.6 | 12,903 | 4.0 |
SOURCE [Authors’ analysis of data from CMS Medicaid data from 2008–2016]
a
Hierarchical classification results presented from 45 states; hierarchical classification results restricted to the 20 states matching Stephen Crystal et al (2016)(6) are available on request.