Epidemiological Trends in the Use of Methylphenidate Among Children in Israel
Lutfi Jaber, M.D.1, Gary Diamond, M.D.2
1The Bridge to Peace Community Pediatric Center, Taibe; 1,2 Center for Pediatric Neurology and Child Development, Schneider Children's Medical Center of Israel, Petah Tiqva. E-mail: firstname.lastname@example.org
Objective: To characterize the use of methylphenidate (MPH) in the treatment of ADHD in the pediatric age group in terms of prescription trends and the demographic features of the users.
Methods: The details of all prescriptions for MPH filled during 2011, in both the Sharon-Shomron and Dan-Petah Tiqva regions, were drawn from the data base of the Clalit Health Services. The study included children age 6-18 years, who were residents of these areas and had received at least one prescription for MPH during the year. To determine prescription patterns over time, data for the year 2007 in the Sharon-Shomron region were also drawn. Demographic characteristics of gender and family SES, based on clinic location, were also culled from the data base. Since neighborhoods in Israel tend to clearly segregate along demographic lines, nine locations were specifically selected from the Dan-Petah Tiqva region to participate in the study, in order to compare prescription trends based on SES, religious affiliation and ethnicity.
Results: The 119,913 children of the Sharon-Shomron region were surveyed. Of these, 9025 received prescriptions for MPH, at an overall one year prevalence rate of 7.52%, with 10.8% in Jewish children and 2.54% in Arab children, representing a four-fold difference. Overall prevalence for the year 2007, by comparison, was 3.9%, 6% among Jewish children and 0.06% among Arab youngsters. According to the type of settlement in the Sharon-Shomron area for 2011, MPH usage ranged from 18.9% on the kibbutzim, to 2.5% in the urban Arab areas, a 7.5 fold difference. Males represented 10% of the group cohort, whereas girls, 4%, a 2.5 fold gender difference in prescription rates. Of the 21,811 children surveyed in the Dan-Petah Tiqva region 1325 were prescribed MPH, at an overall prevalence rate of 6%, with 6.9% among Jewish children and 2% in the Arab sector, a 3.5 fold difference. Within each ethnic community of Dan-Petah Tiqva, correlations with gender, SES, and religious affiliation were shown, with SES being the dominant factor cutting across ethnic and religious lines.
Conclusions: Both the diagnosis and the decision to treat ADHD with MPH follows both clinical indications, as well as SES and cultural norms. The study emphasizes glaring differences according to gender and ethnic affiliation. However present trends do indicate a slow, but progressive closing of the gap along ethnic lines.