Patterns and correlates of tic disorder diagnoses in privately and publicly insured youth.
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.


METHODS
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.
College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA.
Mark
M
Olfson
Stephen
S
Crystal
Tobias
T
Gerhard
Cecilia
C
Huang
James T
JT
Walkup
Lawrence
L
Scahill
John T
JT
Walkup
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services; D015999:Multivariate Analysis; D015995:Prevalence; D005879:Tourette Syndrome / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology