Racial disparities in bladder cancer stage, grade, treatment and adjusted survival continue to exist between white and black Americans despite improvements in stage presentation and survival of localized and regional disease. These data provide the rationale to study treatment decision making, access, delay and potential bias in the black community.

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PURPOSE In order to assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically-treated suicidal behavior in a cohort of children and adolescents. DESIGN/METHODS The cohort included 80,183 youth (6–18 years) enrolled in Tennessee’s Medicaid program from 1995–2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred. RESULTS Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide & self-inflicted injury, poisoning by drugs, or both. The positive predictive value (PPV) of code groups to predict suicidal behavior ranged from 0–88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior. CONCLUSIONS Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the PPV for identifying medically-treated suicidal behavior.

Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aims of this study were to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. Methods We conducted a large cohort study of youth, ages 7–18, enrolled in Tennessee Medicaid from 1995–2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal based on external cause-of-injury codes (E-codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization and discharge instructions. Results Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (AOR 0.72; 95% CI 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Females were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. Conclusions In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.

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