Mental Health, Nonadherence, and Healthcare Utilization in Pediatric Solid Organ Transplantation: Evidence From a Multistate Cohort.

Mental health diagnoses were common among pediatric solid organ transplant recipients in this cohort.

• Data were drawn from 2037 pediatric SOT recipients (ages 0-25 years) within the OneFlorida+ Data Trust (2012-2018).
• Anxiety was diagnosed in 21.6% of patients.
• Depression was diagnosed in 15.3% of patients.
• ADHD was diagnosed in 13.7% of patients.
• PTSD was diagnosed in 13.1% of patients.

Clinician-documented medication nonadherence occurred in 13.3% of pediatric SOT recipients and was associated with older age, non-White race, depression, and anxiety.

• Nonadherence was identified in 13.3% of the 2037 patients using ICD-9/10-CM codes.
• Depression was associated with nonadherence with an odds ratio of 2.85 (95% CI 1.75-4.62).
• Anxiety was associated with nonadherence with an odds ratio of 2.29 (95% CI 1.62-3.23).
• Older age and non-White race were also identified as predictors of nonadherence.
• Predictors were estimated using logistic regression adjusted for demographic and clinical covariates including age, sex, race, ethnicity, and organ type.

Nonadherence independently predicted approximately twice the rate of both emergency department and inpatient visits.

• Nonadherence was associated with an incidence rate ratio of 2.02 (95% CI 1.68-2.43) for emergency department visits.
• Nonadherence was associated with an incidence rate ratio of 2.00 (95% CI 1.67-2.40) for inpatient visits.
• Utilization outcomes were estimated using negative binomial regression models with log-offsets for follow-up time.
• These associations were independent of demographic and clinical covariates.

Anxiety and PTSD remained significant independent predictors of elevated healthcare utilization across models.

• Anxiety and PTSD remained significant predictors of both emergency department and inpatient visit rates after adjustment.
• Models adjusted for demographic and clinical covariates including age, sex, race, ethnicity, and organ type.
• These associations were observed even after accounting for nonadherence in the models.