Gender Differences Appear in Drug-Dispensing Data
Prescription-drug data analyzed by Medco Health Solutions, one of the country's largest pharmacy-benefit managers, indicates that an increasing number of prepubescent and adolescent girls in the United States are being prescribed drugs to treat psychiatric illnesses, sleep ailments, and behavioral problems such as attention-deficit/hyperactivity disorder (ADHD).
Moreover, compared with young boys, the increase in the prevalence rates of psychotropic prescriptions dispensed to girls, is dramatic. According to Medco, from 2001 to 2006 the percentage increase in the prevalence rate of girls dispensed psychotropic and sleep medications far outpaced the increase for boys prescribed and dispensed the same drugs.
The analysis, which was not peer reviewed, looked at prescription drug claims—for both physical and psychiatric illnesses—managed by Medco from 2001 to 2006 for 370,000 medically insured youth (roughly half boys and half girls) aged 10 to 19 in the United States.
The data that were reviewed and analyzed were culled from Medco's 2007 Drug Trend Report, the ninth in a series of such annual reports. According to Medco, the data are representative of an insured population.
The biggest prescription-dispensing increase for girls over the study period was for medications to treat diabetes. According to numerous reports, diabetes is a growing childhood problem that can have psychological ramifications. The prevalence rate of girls dispensed diabetes medications jumped 167 percent over the study period, compared with 91 percent for boys.
Girls' Health Raises 'Red Flags'
Some experts believe that Medco's large database prescription claims analysis suggests a growing prevalence of psychologically troubled young girls.
“While this may be evidence that more girls are, for the first time, being appropriately diagnosed and treated, it also raises red flags about the physical and psychological problems afflicting this population,” Robert Epstein, M.D., Medco's chief medical officer, said in a press statement.
“Overall, the findings are consistent with previous studies and with impressions from general clinical practice,” David Fassler, M.D., told Psychiatric News. However, “in many ways, the findings raise more questions than they answer.”
Fassler, a child and adolescent psychiatrist, is an APA trustee and a clinical professor of psychiatry at the University of Vermont College of Medicine.
Among the prescription-writing trends revealed by Medco's study were the following:
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Antipsychotics: The prevalence rate of girls dispensed antipsychotic medications steadily increased from 3.4 of every 1,000 medically insured girls in the same age group in 2001 to 6.7 in 2004, then to 7.5 in 2006—a jump of 117 percent over the study period. In comparison, the prevalence rate for boys dispensed antipsychotic medications increased from 6.9 per 1,000 medically insured boys in the same age group in 2001, to 11.2 boys in 2004, then to 11.9 boys in 2006—for an overall rise of nearly 71 percent.
According to Medco, the antipsychotics primarily being prescribed are the second-generation ones such as risperidone, olanzapine, clozapine, ziprasidone, and quetiapine. They were prescribed to treat, among other conditions, bipolar disorder, conduct disorder, ADHD, depression, and Tourette's syndrome.
•
Sleep medications: The prevalence rate of girls dispensed sleep medications rose over the study period from 2.4 per 1,000 medically insured girls in the same age group in 2001 to 4.3 girls per 1,000 in the same age group in 2006, representing an 80 percent increase. In comparison, the percentage of boys dispensed sleep medications grew 64 percent, starting with a prevalence rate of 1.8 boys per 1,000 in 2001 and ending with a prevalence rate of 3 per 1,000 by 2006.
•
ADHD: The prevalence rate of boys dispensed ADHD medications remained greater overall than for girls for each of the study years. In fact, the lowest prevalence rate for boys (57 boys per 1,000 medically insured boys in the same age group in 2001) was far higher than the highest prevalence rate for girls (35 per 1,000 medically insured girls of the same ages in 2006).
Still, by the end of the five-year study period, the rise in the prevalence rate for girls dispensed ADHD medications was double that for boys—74 percent versus 37 percent.
One reason for this change, according to Medco, may be better diagnosis of young girls with ADHD. “New research out of the University of California, Berkeley, found that adolescent girls diagnosed with ADHD are less prone to hyperactivity than boys, but are more likely to exhibit other emotional and behavioral issues, including depression and eating disorders. Additional findings show that girls have historically been underdiagnosed with ADHD because they don't display the impulsive and disruptive behavior often seen in boys with the condition,” Medco researchers said in a statement accompanying release of the findings.
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Antidepressants: The prevalence rate of antidepressant prescriptions filled for girls increased only slightly during the study period. The pattern within that period, however, was unusual: it started at 38 per 1,000 in 2001, increased to a high of 48.29 in 2004, then evened out at 42 in 2005 and 2006. The pattern for boys, meanwhile, showed hardly any change in prevalence rate. The rate was 32 per 1,000 in 2001, then reached a high of 37 in both 2003 and 2004, and dropped back to 32 in 2006.
During the study period, concerns over the potential increased risk of suicidal thoughts and behaviors in children and adolescents taking antidepressants became widespread. In late 2003 the Food and Drug Administration (FDA) issued its first public advisory cautioning about the use of antidepressants in children. In 2004 the agency ordered black-box warnings added to antidepressant labeling. According to many experts, the FDA's actions and the resultant publicity created a backlash against prescribing antidepressants for youngsters.
Interpretation Uncertain
Fassler said he is concerned that the design of Medco's analysis was not peer reviewed or published in its entirety beyond the company's Web site.
“In many ways, the findings raise more questions than they answer,” he said. For example, it is important to know whether the population studied remained comparable over time. “I would also want to know who was doing the prescribing and whether the children were receiving other interventions in addition to medication,” he said.
“Ultimately, the real issue is not simply how many prescriptions are being written on an annual basis,” he continued. “The more relevant question is, Are the right children, adolescents, and adults receiving the most effective and appropriate intervention possible?”
Lon Castle, M.D., the lead author of Medco's “2007 Drug Trend Report,” agreed with Fassler.
“Further study will have to answer those questions,” said Castle, director of medical policy and programs at Medco. The purpose of the report, he noted, is to inform payers, primary care and specialty physicians, and other stakeholders about what medications are being prescribed and presumably used right now to “get this information out into the public domain in real time. It's up to the clinicians [and researchers] to determine and explore why it is happening.”
Castle, however, was able to respond to Fassler's question regarding who is prescribing psychotropic medications to young girls, as well as to young boys.
It is mostly the primary care physicians doing the prescribing, and that includes pediatricians, Castle said.
More information about the Medco study can be accessed under“ Latest News” at<www.medco.com>. Medco's 2007 Drug Trend Report can be accessed at the same Web address under“ Media” by clicking on “Drug Trend Resource Center.” ▪
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Published online: 3 August 2007
Published in print: August 3, 2007
Notes
Young girls in the United States are outpacing boys in filling medically prescribed medications for sleep, psychological, and behavior disorders.
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