TABLE 2.
Medicaid-Reimbursed Psychotropic Medication Use Among Children With ASDs According to County and State Characteristics (N =60 641)
| Parameter | Any Psychotropic Medication, % | ≥3 Concurrent Psychotropics, % | Psychotropic Medication Class, % |
|||||
|---|---|---|---|---|---|---|---|---|
| Antidepressant | Neuroleptic | Anxiolytic | Mood Stabilizer | Sedative | Stimulant | |||
| % of county living in urban areasa | ||||||||
| First quartile (0%–63%) | 61 | 12 | 30 | 32 | 13 | 24 | 3 | 26 |
| Second quartile (64%–87%) | 60 | 12 | 29 | 33 | 14 | 23 | 3 | 25 |
| Third quartile (88%–98%) | 56 | 11 | 26 | 32 | 12 | 23 | 3 | 21 |
| Fourth quartile (99%–100%) | 46 | 7 | 15 | 26 | 8 | 16 | 3 | 18 |
| Median county household income | ||||||||
| First quartile ($16 435–$35 574) | 61 | 12 | 27 | 32 | 14 | 23 | 4 | 26 |
| Second quartile ($35 575–$40 274) | 52 | 9 | 23 | 27 | 10 | 18 | 3 | 23 |
| Third quartile ($40 275–$44 360) | 55 | 9 | 21 | 32 | 11 | 21 | 3 | 19 |
| Fourth quartile ($44 394–$93 316) | 56 | 11 | 27 | 31 | 12 | 22 | 3 | 21 |
| Pediatricians per capita by countya | ||||||||
| First quartile (0.00–0.32 per 1000) | 62 | 13 | 30 | 33 | 13 | 24 | 3 | 26 |
| Second quartile (0.33–0.52 per 1000) | 58 | 12 | 28 | 32 | 13 | 22 | 3 | 24 |
| Third quartile (0.53–0.86 per 1000) | 50 | 9 | 21 | 27 | 10 | 19 | 3 | 20 |
| Fourth quartile (0.87–4.56 per 1000) | 55 | 9 | 21 | 31 | 11 | 20 | 3 | 20 |
| Pediatric specialists per capita by countya | ||||||||
| First quartile (0.00–0.02 per 1000) | 61 | 12 | 30 | 33 | 14 | 24 | 4 | 25 |
| Second quartile (0.03–0.12 per 1000) | 60 | 12 | 28 | 33 | 13 | 23 | 3 | 24 |
| Third quartile (0.13–0.23 per 1000) | 48 | 9 | 20 | 27 | 9 | 18 | 3 | 20 |
| Fourth quartile (0.24–4.32 per 1000) | 55 | 9 | 22 | 32 | 11 | 21 | 3 | 20 |
| % white by county | ||||||||
| First quartile (5%–56%) | 46 | 6 | 15 | 25 | 8 | 15 | 3 | 18 |
| Second quartile (57%–76%) | 59 | 11 | 25 | 34 | 13 | 23 | 4 | 23 |
| Third quartile (77%–90%) | 59 | 12 | 28 | 33 | 13 | 24 | 4 | 24 |
| Fourth quartile (91%–99%) | 60 | 12 | 31 | 31 | 12 | 23 | 3 | 25 |
| ASD Medicaid penetration by countya | ||||||||
| First quartile (0.04–0.58 per 1000) | 58 | 12 | 27 | 35 | 13 | 24 | 4 | 21 |
| Second quartile (0.59–0.95 per 1000) | 58 | 11 | 26 | 33 | 12 | 23 | 3 | 22 |
| Third quartile (0.96–1.79 per 1000) | 59 | 12 | 29 | 31 | 13 | 22 | 3 | 25 |
| Fourth quartile (1.80–32.5 per 1000) | 48 | 8 | 19 | 25 | 9 | 16 | 3 | 21 |
| ASD education penetration by statea | ||||||||
| First quartile (0.002–0.011 per 1000) | 46 | 9 | 20 | 25 | 9 | 17 | 2 | 19 |
| Second quartile (0.012–0.030 per 1000) | 56 | 9 | 22 | 32 | 11 | 21 | 3 | 21 |
| Third quartile (0.031–0.107 per 1000) | 60 | 11 | 28 | 33 | 13 | 23 | 4 | 24 |
| Fourth quartile (0.108–15.400 per 1000) | 62 | 12 | 30 | 34 | 13 | 24 | 4 | 26 |
| Census regiona | ||||||||
| Midwest (n =18 557) | 53 | 10 | 26 | 28 | 9 | 21 | 2 | 24 |
| Northeast (n =12 447) | 55 | 9 | 22 | 32 | 11 | 20 | 4 | 20 |
| South (n =18 735) | 61 | 12 | 26 | 33 | 15 | 23 | 4 | 26 |
| West (n =10 898) | 52 | 10 | 25 | 30 | 11 | 21 | 3 | 16 |
a
Statistically significant at P <.0002 based on random-effects model to account for clustering by county and state.