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Background <p>Surveillance of diagnosed mental health conditions is essential for understanding geographic disparities in healthcare access and guiding public health policy. Previous studies provide national or state-level prevalence estimates with limited geographic granularity and few comparisons between insurance types. The aim of this study was to (1) estimate geographical-varying prevalence of diagnosed mental health conditions among Medicaid-insured and commercially-insured children; (2) examine geographic variations in prevalence across urban, suburban, and rural communities; (3) identify census tracts with significantly high and low prevalence; and (4) compare prevalence patterns between public and commercial insurance, and across geographic areas.</p> Methods <p>We evaluated the prevalence of MH diagnoses among children (3–17 years) using the 2018 Transformed Medicaid Analytic Files and 2018 claims database of a large commercial insurance provider. We applied spatial projection and smoothing to estimate census tract-level prevalence for overall MH conditions, ADHD, depression, and anxiety.</p> Results <p>The overall diagnosed-MH prevalence was 11.8% in the Medicaid-insured population compared to 5.5% in the commercially insured population. Suburban communities had higher prevalence rates (Medicaid: MH-15.8%, ADHD-7.7%, Depression-3.2%, Anxiety-0.9%; Commercial: MH-5.2%, ADHD-2.4%, Depression-1.1%, Anxiety-0.2%) than rural or urban communities in both the Medicaid-insured and commercially insured populations. Seven states had significantly lower diagnosed-MH prevalence than 30 or more other states. Most states had few to no tracts with low diagnosed-MH prevalence, but some states had high percentages (e.g., 10.0% in urban Florida for Medicaid, 8.7% in urban California for commercial insurance). Conversely, few states had approximately zero tracts with high diagnosed-MH prevalence, with the highest percentages being 8.9% in urban Montana for Medicaid, 9.3% in urban Minnesota for commercial insurance, 7.0% in rural Maine for Medicaid, and 4.8% in rural Massachusetts for commercial insurance.</p> Conclusion <p>Variations in prevalence differed widely across states and by communities’ rurality-urbanity. Medicaid-insured children had consistently higher prevalence than commercially insured children throughout all states. Suburban communities demonstrated the highest prevalence rates for both insurance types, with geographic clustering of high-prevalence areas observed particularly in eastern states for Medicaid-insured children and primarily in urban areas for commercially insured children.</p>

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Prevalence of diagnosed mental health conditions among US children with public and commercial insurance

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Wanmeng Liu,
  • Yujia Xie,
  • Sarah Vinson,
  • Jiaxi Yu,
  • Nicoleta Serban

摘要

Background

Surveillance of diagnosed mental health conditions is essential for understanding geographic disparities in healthcare access and guiding public health policy. Previous studies provide national or state-level prevalence estimates with limited geographic granularity and few comparisons between insurance types. The aim of this study was to (1) estimate geographical-varying prevalence of diagnosed mental health conditions among Medicaid-insured and commercially-insured children; (2) examine geographic variations in prevalence across urban, suburban, and rural communities; (3) identify census tracts with significantly high and low prevalence; and (4) compare prevalence patterns between public and commercial insurance, and across geographic areas.

Methods

We evaluated the prevalence of MH diagnoses among children (3–17 years) using the 2018 Transformed Medicaid Analytic Files and 2018 claims database of a large commercial insurance provider. We applied spatial projection and smoothing to estimate census tract-level prevalence for overall MH conditions, ADHD, depression, and anxiety.

Results

The overall diagnosed-MH prevalence was 11.8% in the Medicaid-insured population compared to 5.5% in the commercially insured population. Suburban communities had higher prevalence rates (Medicaid: MH-15.8%, ADHD-7.7%, Depression-3.2%, Anxiety-0.9%; Commercial: MH-5.2%, ADHD-2.4%, Depression-1.1%, Anxiety-0.2%) than rural or urban communities in both the Medicaid-insured and commercially insured populations. Seven states had significantly lower diagnosed-MH prevalence than 30 or more other states. Most states had few to no tracts with low diagnosed-MH prevalence, but some states had high percentages (e.g., 10.0% in urban Florida for Medicaid, 8.7% in urban California for commercial insurance). Conversely, few states had approximately zero tracts with high diagnosed-MH prevalence, with the highest percentages being 8.9% in urban Montana for Medicaid, 9.3% in urban Minnesota for commercial insurance, 7.0% in rural Maine for Medicaid, and 4.8% in rural Massachusetts for commercial insurance.

Conclusion

Variations in prevalence differed widely across states and by communities’ rurality-urbanity. Medicaid-insured children had consistently higher prevalence than commercially insured children throughout all states. Suburban communities demonstrated the highest prevalence rates for both insurance types, with geographic clustering of high-prevalence areas observed particularly in eastern states for Medicaid-insured children and primarily in urban areas for commercially insured children.