Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland

J Am Acad Child Adolesc Psychiatry. 1998 Feb;37(2):179-84. doi: 10.1097/00004583-199802000-00010.


Design: A retrospective analysis was conducted using state Medicaid prescription drug reimbursement claims for youths aged 5 through 14 years according to the race of the recipients of psychotropic and medical drugs.

Method: A person-based data set was created from Medicaid administrative data for fiscal year 1991 from the state of Maryland to yield the following: (1) estimates of prevalence of prescription recipients per 100 eligible enrollees; (2) relative prescription use ratios according to race (African-American versus Caucasian); and (3) the interrelation of race and geographic region on prescription prevalence.

Results: Five major findings were observed: (1) African-American youths with Medicaid insurance aged 5 through 14 were less than half (39% to 52%) as likely to have been prescribed psychotropic medications as Caucasian youths with Medicaid insurance; (2) the relative difference for nonpsychotropic medication classes was much less pronounced: African-American youths were prescribed nonpsychotropic medications at a rate 60% to 87% of the Caucasian youths' rate; (3) the stimulants (essentially methylphenidate) had the most disparate African-American/Caucasian ratio (1:2.5); (4) the racial disparity for psychotropics was not altered by partial (noncontinuous enrollment) eligibility status; and (5) although geographic variation reduced the racial disparity, the substantial racial difference (1:2.0) remained.

Conclusion: Compared with Caucasians, African-American youths aged 5 through 14 with Medicaid insurance coverage showed a distinctly lower rate of treatment with psychopharmacological agents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • African Americans / statistics & numerical data*
  • Attitude to Health / ethnology
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Drug Prescriptions / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Maryland
  • Medicaid / statistics & numerical data*
  • Odds Ratio
  • Practice Patterns, Physicians' / statistics & numerical data
  • Psychotropic Drugs*
  • Retrospective Studies
  • United States


  • Psychotropic Drugs