Richard Feng Melanie Thomas Connie Chen James Dilley

Richard Feng, Melanie Thomas, Connie Chen, James Dilley, Thao Tran, Christina Mangurian University of California, San Francisco and San Francisco General Hospital Non-ADHD Population Background: Objectives: • Adult Attention Deficit Hyperactivity Disorder (ADHD) is a chronic, disabling psychiatric disorder • Determine whether racial/ethnic disparities exist in the diagnosis of adult ADHD in the San Francisco county mental health system • Prevalence of adult ADHD is similar worldwide, roughly 4% across racial/ethnic groups. • Studies suggest racial/ethnic disparities in rates of pediatric ADHD diagnosis, raising questions of similar disparities in adult patients • San Francisco Community Behavioral Health Services (CBHS), a county mental health system, treats a diverse patient population Methods/Procedures: Total population Gender, % (n) n=4020 Male 52 (2116) Female 47 (1898) White 63% Other 15% Asian 43% Black 12% White Black Asian Other Asian 17% Black 4% White Black Asian Other Results: Discussion/Conclusion: • Black and Asian patients are significantly less likely to be diagnosed with ADHD than White patients across the three study clinics • Results suggest under diagnosis of ADHD among Asian and Black populations, as well as non primary English language speaking patients, served within a county public mental health care system. • Primary English speaking patients are significantly more likely to be diagnosed with ADHD than non primary English speaking patients • Possible explanations for the racial/ethnic disparities include cultural stigma against receiving treatment, clinician bias, lack of familiarity and linguistic challenges. • No statistically significant difference by gender for ADHD diagnosis in our study population Table 2: Demographics of ADHD patients vs. total population • Adults aged ≥ 18 at one of three outpatient mental health clinics of the San Francisco Community Behavioral Health Services (CBHS) between November 2013 and November 2014. Race, % (n) • Demographic and other patient-specified variables, including racial/ethnic data, will be collected from electronic medical records • T-tests to determine whethere appear to be any disparities in diagnosis based upon race/ethnicity. White 31% Table 1: Demographics of study population • Cross-sectional study • The population of adults with ADHD (n=88) will be characterized and compared to patients at clinics without ADHD (n 4020) Other 14% ADHD Population White 30 (1208) Black 12 (520) Asian 42 (1713) Other 14 (581) Language, % (n) English Other 57 (2320) 42 (1700) Gender, % (n) Male Female Race, % (n) White Black Asian Other Language, % (n) English Other ADHD population n=88 non-ADHD population Z-score n=4020 P-value 62 (55) 37 (33) 52 (2116) 47 (1898) 0. 067 0. 070 62 (55) 4 (4) 17 (15) 15 (14) 30 (1208) 12 (520) 42 (1713) 14 (581) 1. 83 -1. 81 6. 53 -2. 33 -4. 81 0. 38 <0. 001 0. 020 <0. 001 0. 704 • It is also possible that Caucasian populations are over diagnosed with ADHD. • Limits include reliance on an Electronic Medical Records system, and on user entered demographic and clinical data. • Due to limits in the EMR system, we were unable to access overall clinic data on Hispanic ethnicity • Results from this study may encourage enhanced education and development of more culturally appropriate and sensitive care. Acknowledgements/Contact Info: • This work was supported by the San Francisco Department of Public Health, Community Behavioral Health Services • Richard. feng@ucsf. edu 94 (83) 5 (5) 57 (2320) 42 (1700) 6. 89 -6. 89 <0. 001 • No disclosures