Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups.
Level 3 - non-randomized controlled study
Large retrospective cohort study analyzing electronic health records across a single regional health system.
PubMed 31675080 · doi:10.1001/jamanetworkopen.2019.14344
What was done
A retrospective cohort study examined electronic medical records from Kaiser Permanente Northern California between January 1, 2007, and December 31, 2016. The cohort included 5,282,877 adults and 867,453 children aged 5 to 11 years. Researchers assessed time trends in licensed clinician-diagnosed ADHD across seven racial and ethnic groups, along with demographic, psychiatric, and health outcome associations.
What was found
Adult ADHD prevalence rose from 0.43% in 2007 to 0.96% in 2016 (59,371 total adults diagnosed; 1.12%), and incidence increased from 9.43 to 13.49 per 10,000 person-years. Childhood prevalence rose from 2.96% to 3.74%. While adult prevalence increased across all racial and ethnic groups, white adults consistently had the highest rates (0.67% to 1.42%), compared with Native American (0.56% to 1.14%), Black (0.22% to 0.69%), Hispanic/Latino (0.25% to 0.65%), Pacific Islander (0.11% to 0.39%), and Asian American adults (0.11% to 0.35%; Asian vs. white OR, 0.248; 95% CI, 0.240-0.257). Higher odds of diagnosis were also associated with younger age, male sex, higher education (OR, 2.156), eating disorders (OR, 5.192), bipolar disorder (OR, 4.722), depression (OR, 4.118), anxiety (OR, 2.438), STIs (OR, 1.289), and high healthcare utilization (OR, 1.303; all P < .001).
Why it matters
This study documents a rapid rise in adult ADHD diagnoses over a decade and demonstrates marked racial and ethnic disparities in clinical detection within an insured population.
Limits
The study relied entirely on administrative and diagnostic codes from a single integrated private healthcare system in Northern California, which excludes uninsured populations. The data capture clinical diagnoses rather than true community prevalence, making it impossible to separate diagnostic bias or access disparities from actual differences in underlying condition frequency.
Cited by
- supports There is an increasing trend of adults in their 30s, 40s, 50s, and 60s receiving new diagnoses of ADHD.