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Patterns and Correlates of Tic Disorder Diagnoses in Privately and Publicly Insured Youth

The study methods and a summary of the preliminary data were presented at the 4th International Clinical and Scientific Symposium on Tourette Syndrome in New York, New York, on June12, 2009. The report is an independent and complete work of the authors. No part of this article has been published previously. No subsequent publication from this specific dataset is planned.
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Objective

This study examined the prevalence and demographic and clinical correlates of children diagnosed with Tourette disorder, chronic motor or vocal tic disorder, and other tic disorders in public and private insurance plans over the course of a 1-year period.

Method

Claims were reviewed of Medicaid (n = 10,247,827) and privately (n = 16,128,828) insured youth (4-18 years old) focusing on tic disorder diagnoses during a 1-year period. Rates are presented for children with each tic disorder diagnosis overall and stratified by demographic characteristics and co-identified mental disorders. Mental health service use, including medications prescribed, and co-existing psychiatric disorders were also examined.

Results

In Medicaid-insured children, rates of diagnosis per 1,000 were 0.53 (95% confidence interval [CI] 0.51-0.55) for Tourette disorder, 0.08 (95% CI 0.07-0.08) for chronic motor or vocal tic disorder, and 0.43 (95% CI 0.41-0.44) for other tic disorders. In privately insured children, comparable rates were 0.50 (95% CI 0.49-0.52), 0.10 (95% CI 0.10-0.11), and 0.59 (95% CI 0.58-0.61). In 1 year, children diagnosed with tic disorders also frequently received other psychiatric disorder diagnoses. Compared with privately insured youth, children under Medicaid diagnosed with Tourette disorder had higher rates of attention-deficit/hyperactivity disorder (50.2% versus 25.9%), other disruptive behavior (20.6% versus 5.6%), and depression (14.6% versus 9.8%) diagnoses and higher rates of antipsychotic medication use (53.6% versus 33.2%).

Conclusions

Despite similarities in annual rates of tic disorder diagnoses in publicly and privately insured children, important differences exist in patient characteristics and service use of publicly and privately insured youth who are diagnosed with tic disorders.

Section snippets

Data Sources

Service and pharmacy claims were examined from the MarketScan Research Databases (2000-2007) and a seven-state Medicaid Analytic Extract File (2001-2004) including California, Florida, New York, Texas, Illinois, Georgia, and Ohio. The states were selected for their large Medicaid populations, geographic diversity, and relatively low penetration of Medicaid managed care. MarketScan data include information from privately insured individuals and their family members. The data were collected

Rates of Tic Disorder Diagnosis by Demographic Characteristics

Annual rates of children with a Tourette disorder diagnosis did not differ substantially between private and public insurance plans. Children with chronic motor or vocal tic disorder were much less common than children with Tourette disorder and were somewhat more prevalent in private than public insurance plans (Table 1). The annual rates for children with any tic disorder diagnosis were 1.19 per 1,000 in the private insurance plans and 1.04 per 1,000 in public insurance (data not shown).

On an

Discussion

On the basis of claims patterns, a gradient of tic disorder diagnoses from unspecified and transient symptoms to the more chronic (chronic motor or vocal tic disorder) and potentially severe (Tourette disorder) tic disorders was observed in children in this study. This gradient was also associated with increasing rates of coexisting psychiatric disorder diagnoses, filled psychotropic prescriptions, and use of mental health services. A similar spectrum from milder and transient to persistent and

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  • Cited by (0)

    This work was supported by award U18-HS016097 from the Agency for Healthcare Research and Quality (Center for Education and Research on Mental Health Therapeutics).

    This article was reviewed under and accepted by Ad Hoc Editor James F. Leckman, M.D.

    Drs. James T. Walkup and John T. Walkup are not related but have enjoyed the opportunity to work together on this project.

    Disclosure: Dr. Olfson has received grant funding from Eli Lilly and Co. and Bristol Myers-Squibb. Dr. Scahill has served as a consultant to Shire Pharmaceuticals, NeuroSearch, Pfizer, and Boehringer-Ingelheim. He has also received research support from Shire and Seaside Therapeutics and received speaking honoraria for talks funded by a joint Tourette Syndrome Association-Center for Disease Control outreach and education program. He has received royalties from Oxford University Press and American Psychiatric Association Press. Dr. John T. Walkup has received active drug and placebo from Eli Lilly and Co. and Pfizer, and free drug from Abbott for National Institute of Mental Health-funded studies. He is also the Chair of the Medical Advisory Board of the Tourette Syndrome Association and receives travel support for meetings. He also has received honoraria for talks funded by a joint Tourette Syndrome Association-Center for Disease Control outreach and education program. He also receives royalties from Oxford University Press and Guilford Press. Drs. Crystal, Gerhard, Huang, and James T. Walkup report no biomedical financial interests or potential conflicts of interest.

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