Rising Prevalence of Parent-Reported Learning Disabilities among U.S. Children and Adolescents Aged 6-17 years: NSCH, 2016-2022

Rising Prevalence of Parent-Reported Learning Disabilities among U.S. Children and Adolescents Aged 6-17 years: NSCH, 2016-2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Rising Prevalence of Parent-Reported Learning Disabilities among U.S. Children and Adolescents Aged 6-17 years: NSCH, 2016-2022 Chan Xu, Yanmei Li, Huijuan Yu, Qishan Li, Yingyu Liang, Kefan Zhou, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4749516/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The prevalence of learning disabilities (LD) among children is a critical public health issue; however, recent LD prevalence estimates among children and adolescents aged 6–17 years, as reported by the National Survey of Children’s Health (NSCH), remain largely unexplored. Data for this population-based cross-sectional study were obtained from NSCH to estimate the prevalence of LD diagnosis among U.S. children at both national and state levels, and to inspect the 7-year trends in these estimates from 2016 to 2022. Among 187,805 U.S. children, 17,379 had a history of LD diagnosis, with a weighted prevalence of 8.80% (95% CI = 8.52–9.08). Of these, 16,221 were currently diagnosed with LD, yielding a weighted prevalence of 8.20% (95% CI = 7.93–8.48). From 2016 to 2022, the prevalence of ever-diagnosed LD increased from 7.86–9.45%, and that of current-diagnosed LD from 7.32–8.80%, indicating a 20% total increase in both types. The state with the highest prevalence (New Hampshire) had twice that of the state with the lowest prevalence (Utah). This study highlights a critical escalation in LD prevalence among US children and adolescents between 2016 and 2022. Comprehensive screening and support programs must be implemented to enhance early identification and intervention. Biological sciences/Neuroscience Health sciences/Diseases Health sciences/Medical research Learning Disability Epidemiology Child Adolescent NSCH Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Learning disability (LD) is a generic term used to describe a group of heterogeneous disorders manifested by significant difficulties in listening, speaking, reading, writing, thinking, mathematics, or social skills. 1 , 2 These disabilities are specific and life-long, potentially leading to long-term consequences in education, social interaction, and economic performance. 3 , 4 Compared with their peers without LD, children with LD often exhibit a higher vulnerability to mental and behavioral disorders, positing a continuous need for support and interventions throughout their lives. 5 , 6 Over the past decades, learning disabilities have emerged as a major health concern for school-aged children in the United States. 7 Literature reports indicated that the prevalence of LD among children varies from 8.2–9.7%, according to data extracted from the National Health Interview Survey (NHIS) between 1999 to 2006, and the National Survey of Children’s Health in 2003. 7 – 9 Both educators and clinicians have observed an increase in the number of children with learning disabilities. 10 , 11 In a clinician reported study, the prevalence of specific developmental delays, which include learning disabilities, speech, and language delays, surged by 40% from 1979 (1.5%) to 1996 (2.1%) among children aged between 4 to 15 years. 10 Nevertheless, a study indicated no significant annual average change in LD from the NHIS in the United States from 1997 to 2021. 12 The reported prevalence of learning disabilities varies substantially across studies, often due to the barriers to identifying learning disabilities 13 and the heterogeneity of definitions, instruments used, and study designs. 5 , 14 Despite the reliability of NHIS studies, further scrutiny of more recent data is warranted to derive deeper understanding of trends in learning disability prevalence. The National Survey of Children’s Health (NSCH) is a significant survey project that aims to investigate children’s health and well-being. Since 2016, the NSCH has adopted the redesigned surveys, moving from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. 15 According to the topical questionnaire, children with special health care needs were more likely to be selected, bolstering the sample size of this targeted population. 16 Therefore, it is worth conducting health surveys to monitor the number and characteristics of children diagnosed with learning disabilities through NSCH data. This is crucial for the formulation of educational policies, early intervention and support, and the improvement of the learning environment for children. In April 2024, The Maternal and Child Health Bureau in conjunction with the Census Bureau revised the imputation and weighting by race and ethnicity for the 2016–2021 NSCH. Following this revision, we have utilized the updated NSCH data to analyze nationally representative information in this study. Our objective is to estimate the most recent prevalence of LD diagnosis among U.S. children and adolescents at both national and state levels, and to inspect the 7-year trends in these estimates from 2016 to 2022. Methods Data Source Data for this study were obtained from the NSCH conducted between 2016 and 2022. The NSCH is a cross-sectional survey was conducted via mail and online by the Data Resource Center (DRC) to collect health information on the welfare of children and adolescents aged 0–17 years in the US. 17 The survey encompasses non-institutionalized children who live with their families or guardians and excludes those residing in institutional settings like orphanages or group homes. Survey respondents were parents or caregivers with at least one child aged 0–17 years who resided in the same household during the entire interview. The funding and oversight for the NSCH are provided by the Health Resources and Services Administration’s Maternal and Child Health Bureau. 18 Ethical approval for all survey procedures is obtained from the National Center for Health Statistics Research Ethics Review Board. Written consent is obtained through electronic submission or paper mailing, and it is returned to the US Census Bureau. 15 The Guangdong Pharmaceutical University Academic Review Board determined the present study was exempt from approval because of the use of de-identified data. The NSCH data collection encompasses all 50 states and the District of Columbia, providing a comprehensive representative of the population in the US. 19 Data Collection The NSCH collected data on a variety of health topics through household interviews. For each family in the household, one child under 18 years old was randomly selected as a sample. Information for this child was collected by interviewing an adult family who was knowledgeable about the child's health. From 2016 to 2022, the weighted Topical Completion Rate ranged from 30.6–30.9%, the weighted Interview Completion Rate ranged from 69.7–78.5% and the weighted Overall Response Rate ranged from 37.4–39.1%. Study Population Parents or caregivers were asked if a doctor, other health care provider or educator had ever told them that their child had “Learning Disability” (Ever LD). Parents or caregivers who responded “Yes” were subsequently asked if their child currently has “Learning Disability” (Current LD). 16 Because learning disabilities are not diagnosed until children enter school, analyses for this study were limited to 187805 children aged 6 to 17 years and excluded children <6 years (n = 90006). 20 Besides, 1735 children were excluded because of missing data on ever diagnosis information (n = 650), current diagnosis information (n = 210) and highest parental education (n = 875) (Fig. 1 ). Study Variables The outcome variable for this analysis were “Ever LD” and “Current LD.” Information on sex, race/ethnicity, family income and highest education of family members were collected using a standardized questionnaire during the interview. The study divided the race/ethnicity into four groups, Hispanic, non-Hispanic whites, non-Hispanic blacks, and other based on the 1997 Office of Management and Budget Standards. The highest educational level of family members was categorized as less than high school, high school, and college or higher. Family income factors included in the analysis were Federal poverty level (FPL), grouped as 0–99%FPL, 100–199%FPL, 200–399%FPL, and 400%FPL or above. 21 Statistical Analysis For this study, analyses were limited to 187805 children and adolescents aged 6–17 years. Weighted estimates were applied according to the NSCH Analytic Guidelines. 16 Population characteristics were shown according to ever and current LD prevalence with 95% confidence interval (CI). Rao-Scott chi-square tests were employed to compare differences of categorical variables. Logistic regression model was used to estimate trends in the prevalence over time, which included the survey year as a continuous variable and adjusted for age, sex, and race/ethnicity, family income, and highest education of family members. All of the statistical analyses were performed using SAS Software, version 9.4. All estimates are weighted based on the complex sampling design of NSCH. The 2 sided statistical significance level was set at α = 0.05. Results Prevalence of Parent-Reported LD in US Children and Adolescents, 2016–2022 This study included 187805 children and adolescents aged 6–17 years (97123 boys [51.71%], 90682 girls [48.29%], 24184 Hispanic [12.88%], 127277 non-Hispanic white [67.77%], 12491 non-Hispanic black [6.65%], 23853 other race/ ethnicity [12.70%]) in 2016–2022. Of the eligible children, 17379 were reported to have ever been diagnosed with LD and the weighted prevalence was 8.80% (95%CI, 8.52–9.08). Among those who had ever been diagnosed as having LD, 16221 were reported to have currently been diagnosed with LD and the weighted prevalence was 8.20% (95%CI, 7.93–8.48) (Table 1 ). The state with the highest prevalence, New Hampshire (12.61% of ever-diagnosed LD and 11.65% of current LD), had twice that of the state with the lowest prevalence, Utah (6.07% of ever-diagnosed LD and 5.70% of current LD) (Fig. 2 ) (Fig. 3 ). Table 1 Prevalence of Diagnosed LD in US Children and Adolescents Aged 6–17 Years, 2016–2022 Characteristic Overall Participants, No.(%) a Ever LD Current LD Participants, No. (%) a Prevalence, % (95% CI) b P Value c Participants, No. (%) a Prevalence, % (95% CI) b P Value c Overall 187805 17379 8.80 (8.52–9.08) 16221 8.20 (7.93–8.48) Age, year 6–11 81647 (43.47) 6600 (37.98) 7.89 (7.48–8.30) < .001 6305 (38.87) 7.50 (7.09–7.90) < .001 12–17 106158 (56.53) 10779 (62.02) 9.70 (9.31–10.09) 9916 (61.13) 8.89 (8.53–9.26) Sex Male 97123 (51.71) 10944 (62.97) 10.72 (10.29–11.14) < .001 10194 (62.84) 9.93 (9.52–10.34) < .001 Female 90682 (48.29) 6435 (37.03) 6.80 (6.43–7.17) 6027 (37.16) 6.40 (6.04–6.76) Race/ethnicity d Hispanic 24184 (12.88) 2238 (12.88) 8.23 (7.49–8.97) < .001 2071 (12.77) 7.57 (6.86–8.29) < .001 Non-Hispanic white 127277 (67.77) 11793 (67.86) 8.72 (8.44–9.01) 11023 (68.96) 8.19 (7.91–8.46) Non-Hispanic black 12491 (6.65) 1480 (8.52) 11.37 (10.43–12.32) 1381 (8.51) 10.50 (9.59–11.40) Other 23853 (12.70) 1868 (10.75) 7.24 (6.59–7.89) 1746 (10.76) 6.85 (6.21–7.50) Highest educational level of family members Less than high school 5167 (2.75) 557 (3.21) 8.42 (7.13–9.70) < .001 524 (3.23) 7.84 (6.6.-9.08) < .001 High school 25765 (13.72) 3155 (18.15) 11.44 (10.63–12.24) 2965 (18.28) 10.75 (9.96–11.53) College or higher 156873 (83.53) 13667 (78.64) 8.11 (7.84–8.38) 12732 (78.49) 7.53 (7.27–7.80) Family income, % FPL e 0–99 22357 (11.90) 3125 (17.98) 12.12 (11.23-13.00) < .001 2952 (18.20) 11.30 (10.45–12.15) < .001 100–199 30549 (16.27) 3504 (20.16) 10.27 (9.55–10.98) 3266 (20.13) 9.55 (8.85–10.24) 200–399 56752 (30.22) 5096 (29.32) 7.95 (7.49–8.41) 4746 (29.26) 7.37 (6.93–7.81) ≥ 400 78147 (41.61) 5654 (32.53) 6.52 (6.20–6.85) 5257 (32.41) 6.12 (5.80–6.44) Abbreviation: LD = Learning Disability; FPL = Federal Poverty Level. a The numbers of participants were unweighted. b Prevalence estimates were weighted. c P value for overall differences in prevalence by stratum. d Race and Hispanic ethnicity were self-reported and classified based on 1997 US Office of Management and Budget standards. Other races and ethnicities included non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Native Hawaiian and Other Pacific Islander, and non-Hispanic multiple race. e The family income-to-poverty ratio is the total family income divided by the poverty threshold. We found that age, sex, race/ethnicity, family income and highest education of family members were significant differences in both Ever LD and Current LD. The weighted prevalence of LD was slightly higher in children aged 12–17 years (Ever LD, 9.70%, 95%CI, 9.31–10.09; Current LD, 8.89%, 95%CI, 8.53–9.26) than in children aged 6–11 years (Ever LD, 7.89%, 95%CI, 7.48–8.30; Current LD, 7.50%, 95%CI, 7.09–7.90). In the sex group, the weighted prevalence of LD was higher in boys (Ever LD, 10.72%, 95%CI, 10.29–11.14; Current LD, 9.93%, 95%CI, 9.52–10.34) than in girls (Ever LD, 6.80%, 95%CI, 6.43–7.17; Current LD, 6.40%, 95%CI, 6.04–6.76). For race/ethnicity and level of family education, we found that the weighted prevalence of LD was highest among non-Hispanic blacks (Ever LD, 11.37%, 95%CI, 10.43–12.32; Current LD, 10.50%, 95%CI, 9.59–11.40) and those with a high school education (Ever LD, 11.44%, 95%CI, 10.63–12.24; Current LD, 10.75%, 95%CI, 9.96–11.53). The weighted ever and current LD prevalence increase with the decrease of family economic level (Table 1 ). Trends in Ever and Current LD in US Children and Adolescents, 2016–2022 The weighted prevalence of Ever LD and Current LD in US children and adolescents aged 6 to 17 years were 7.86% (95%CI, 7.25–8.46) and 7.32% (95%CI, 6.73–7.91) in 2016, 9.08% (95%CI, 7.99–10.16) and 8.69% (95%CI, 7.61–9.76) in 2017, 8.60% (95%CI, 7.84–9.36) and 7.98% (95%CI, 7.24–8.71) in 2018, 8.11% (95%CI, 7.42–8.80) and 7.37% (95%CI, 6.74-8.00) in 2019, 9.22% (95%CI, 8.53–9.92) and 8.71% (95%CI, 8.02–9.39) in 2020, 9.25% (95%CI, 8.58–9.92) and 8.53% (95%CI, 7.90–9.15) in 2021, 9.45% (95%CI, 8.86–10.05) and 8.80% (95%CI, 8.22–9.38) in 2022, respectively ( P for trend < .01). We found a significant average annual change in aged 12–17 years, female, non-Hispanic white, a college or higher education, and family income of 200%FPL or above in the prevalence of both Ever LD and Current LD ( P for trend < .01) (Table 2 ) (Table 3 ) (Fig. 4 ). Table 2 Trends in the Prevalence of Ever Diagnosed LD in US Children and Adolescents Aged 6 to 17 Years, 2016–2022 Characteristic Prevalence of Ever LD, % (95% CI) a P for trend b 2016 2017 2018 2019 2020 2021 2022 Overall 7.86 (7.25–8.46) 9.08 (7.99–10.16) 8.60 (7.84–9.36) 8.11 (7.42–8.80) 9.22 (8.53–9.92) 9.25 (8.58–9.92) 9.45 (8.86–10.05) < .001 Age, year 6–11 6.94 (6.10–7.77) 8.97 (7.23–10.70) 8.36 (7.23–9.49) 7.02 (6.09–7.94) 7.41 (6.56–8.27) 8.05 (7.17–8.93) 8.41 (7.54–9.28) .27 12–17 8.79 (7.91–9.66) 9.18 (7.89–10.48) 8.84 (7.83–9.85) 9.19 (8.17–10.20) 10.96 (9.89–12.04) 10.41 (9.40-11.42) 10.43 (9.60-11.26) < .001 Sex Male 9.55 (8.72–10.38) 11.28 (9.68–12.89) 10.57 (9.40-11.74) 10.14 (9.10-11.19) 11.21 (10.13–12.29) 11.50 (10.41–12.59) 10.74 (9.92–11.57) .05 Female 6.10 (5.21–6.99) 6.77 (5.32–8.21) 6.55 (5.60–7.49) 6.00 (5.12–6.88) 7.15 (6.30–8.01) 6.90 (6.15–7.65) 8.10 (7.23–8.98) .002 Race/ethnicity Hispanic 6.88 (5.27–8.48) 10.02 (6.95–13.09) 8.58 (6.61–10.56) 7.22 (5.54–8.91) 8.12 (6.41–9.82) 8.36 (6.56–10.16) 8.35 (6.95–9.75) .98 Non-Hispanic white 8.14 (7.48–8.80) 7.99 (7.12–8.86) 8.27 (7.51–9.04) 8.33 (7.53–9.12) 9.20 (8.43–9.97) 9.51 (8.80-10.22) 9.67 (8.95–10.39) < .001 Non-Hispanic black 10.34 (8.42–12.25) 12.19 (8.59–15.80) 10.83 (8.28–13.38) 9.95 (7.69–12.22) 12.68 (10.35–15.01) 11.30 (9.26–13.34) 12.27 (10.15–14.39) .26 Other 5.47 (4.30–6.64) 7.54 (4.67–10.40) 7.16 (5.44–8.88) 6.90 (5.36–8.43) 7.64 (5.97–9.30) 7.58 (6.01–9.15) 8.05 (6.81–9.28) .05 Highest educational level of family members Less than high school 8.45 (5.60–11.30) 12.35 (6.53–18.17) 7.09 (4.36–9.82) 7.05 (4.56–9.54) 9.70 (6.56–12.83) 5.71 (3.11–8.32) 8.47 (6.10-10.84) .28 High school 10.14 (8.43–11.85) 12.61 (9.59–15.63) 11.80 (9.68–13.91) 10.83 (8.79–12.78) 11.18 (9.26–13.10) 11.90 (9.90–13.90) 11.62 (9.87–13.37) .52 College or higher 7.07 (6.51–7.63) 7.55 (6.63–8.47) 7.96 (7.15–8.76) 7.51 (6.81–8.22) 8.58 (7.90–9.27) 9.00 (8.33–9.68) 9.01 (8.39–9.63) < .001 Family income, % FPL 0–99 10.93 (9.07–12.80) 14.35 (10.68–18.02) 10.90 (8.92–12.88) 12.24 (9.85–14.62) 12.16 (10.18–14.14) 12.24 (10.25–14.22) 11.97 (10.43–13.50) .97 100–199 8.88 (7.33–10.44) 11.18 (8.44–13.91) 10.46 (8.47–12.46) 9.24 (7.64–10.84) 10.54 (8.92–12.17) 10.89 (9.07–12.70) 10.73 (9.15–12.31) .35 200–399 6.87 (5.99–7.76) 7.15 (5.82–8.47) 7.92 (6.47–9.38) 7.02 (6.01–8.02) 9.18 (7.79–10.58) 7.85 (6.87–8.83) 9.44 (8.23–10.66) < .001 ≥ 400 5.81 (5.15–6.48) 5.79 (4.77–6.82) 6.40 (5.52–7.29) 5.93 (5.04–6.83) 6.60 (5.79–7.40) 7.66 (6.72–8.60) 7.32 (6.57–8.06) < .001 a Prevalence estimates were weighted. b P values for trends were calculated using weighted logistic regression models, which included survey year as a continuous variable and adjusted for age, sex, race/ethnicity, education and family income to poverty ratio. Table 3 Trends in the Prevalence of Current Diagnosed LD in US Children and Adolescents Aged 6 to 17 Years, 2016–2022 Characteristic Prevalence of Current LD, % (95% CI) a P for trend b 2016 2017 2018 2019 2020 2021 2022 Overall 7.32 (6.73–7.91) 8.69 (7.61–9.76) 7.98 (7.24–8.71) 7.37 (6.74-8.00) 8.71 (8.02–9.39) 8.53 (7.90–9.15) 8.80 (8.22–9.38) .002 Age, year 6–11 6.54 (5.74–7.34) 8.79 (7.06–10.53) 7.82 (6.72–8.92) 6.62 (5.73–7.50) 7.00 (6.16–7.84) 7.57 (6.72–8.42) 8.08 (7.22–8.94) .33 12–17 8.10 (7.24–8.96) 8.58 (7.30–9.85) 8.13 (7.16–9.09) 8.611 (7.21-9.00) 10.35 (9.29–11.41) 9.44 (8.54–10.35) 9.48 (8.70-10.26) < .001 Sex Male 8.94 (8.14–9.73) 10.81 (9.22–12.40) 9.73 (8.61–10.85) 9.12 (8.16–10.09) 10.61 (9.54–11.67) 10.44 (9.46–11.43) 9.83 (9.05–10.60) .17 Female 5.63 (4.76–6.51) 6.46 (5.03–7.90) 6.14 (5.22–7.06) 5.54 (4.74–6.34) 6.72 (5.89–7.55) 6.52 (5.79–7.26) 7.73 (6.86–8.59) .002 Race/ethnicity Hispanic 6.48 (4.90–8.05) 9.72 (6.66–12.79) 7.74 (5.83–9.65) 6.51 (4.98–8.04) 7.61 (5.93–9.30) 7.24 (5.68–8.80) 7.67 (6.35-9.00) .68 Non-Hispanic white 7.64 (6.99–8.28) 7.55 (670 − 8.40) 7.76 (7.01–8.50) 7.65 (6.90–8.40) 8.66 (7.91–9.41) 8.89 (8.20–9.58) 9.18 (8.47–9.89) < .001 Non-Hispanic black 9.35 (7.62–11.09) 11.56 (7.99–15.12) 9.99 (7.60-12.39) 8.54 (6.56–10.52) 12.15 (9.84–14.45) 10.73 (8.74–12.72) 11.10 (9.07–13.13) .26 Other 4.98 (3.84–6.12) 7.48 (4.61–10.35) 6.86 (5.16–8.57) 6.65 (5.12–8.17) 7.18 (5.61–8.75) 7.16 (5.61–8.70) 7.39 (6.21–8.57) .10 Highest educational level of family members Less than high school 7.83 (5.12–10.54) 11.98 (6.18–17.78) 6.50 (3.89–9.10) 6.57 (4.17–8.97) 9.38 (6.27–12.49) 4.48 (2.94–6.02) 7.99 (5.66–10.33) .20 High school 9.68 (7.99–11.36) 12.04 (9.05–15.03) 11.08 (9.00-13.15) 9.67 (7.78–11.56) 10.81 (8.90-12.73) 11.03 (9.11–12.95) 10.91 (9.24–12.59) .64 College or higher 6.52 (5.98–7.06) 7.21 (6.30–8.12) 7.35 (6.58–8.12) 6.85 (6.21–7.48) 7.99 (7.33–8.65) 8.39 (7.74–9.04) 8.35 (7.75–8.95) < .001 Family income, % FPL 0–99 10.06 (8.29–11.82) 13.75 (10.10–17.40) 10.18 (8.26–12.11) 11.32 (9.11–13.53) 11.53 (9.58–13.48) 10.94 (9.30-12.58) 11.26 (9.76–12.76) .93 100–199 8.15 (6.63–9.68) 10.78 (8.07–13.49) 9.76 (7.82–11.69) 8.41 (6.92–9.90) 10.00 (8.39–11.60) 10.15 (8.38–11.91) 9.61 (8.16–11.06) .53 200–399 6.59 (5.71–7.47) 6.72 (5.42–8.02) 7.12 (5.75–8.48) 6.15 (5.31–6.99) 8.73 (7.35–10.11) 7.22 (6.29–8.15) 8.88 (7.68–10.09) .002 ≥ 400 5.43 (4.78–6.07) 5.58 (4.57–6.60) 6.04 (5.17–6.91) 5.48 (4.61–6.34) 6.10 (5.34–6.86) 7.19 (6.27–8.12) 6.89 (6.17–7.61) < .001 a Prevalence estimates were weighted. b P values for trends were calculated using weighted logistic regression models, which included survey year as a continuous variable and adjusted for age, sex, race/ethnicity, education and family income to poverty ratio. Discussion In a nationally representative population from the NSCH, we identified a weighted prevalence of ever-diagnosed LD at 8.80% and current-diagnosed LD at 8.20% among US children aged 6–17 years in 2016–2022. Ther was a significant increase in the prevalence of both ever and current LD over the past seven years. In the subgroups, we also found a significant increase in the average annual change in aged 12–17 years, female, non-Hispanic white, a college or higher education, and family income of 200% FPL or above in the prevalence of both ever LD and current LD. The overall prevalence of LD in this study was slightly higher than those reported in other studies. A study analyzing the association between screen time and developmental disabilities among children aged 0–17 years using NSCH data from 2018–2020, noted a total LD prevalence of 7.2%. 22 Similarly, another research conducted by Zablotsky, which utilized NHIS data from 2009–2017, estimated the prevalence at 7.74% among US children aged 3–17 years. 23 Other research using NHIS data between 1997–2021 found lower LD prevalence estimates, ranging from 7.62–8.31%, compared to our current study. 12 , 24 Apart from the overall prevalence, we also found the prevalence differed significantly by age, sex, race/ethnicity, family education, and family income levels from 2016 to 2022, which was similar to other findings. 7 , 23 State-based estimates ranged from 6.07% in Utah to 12.6% in New Hampshire. Learning disabilities are difficult to diagnose, because the age at identification depends not only on the type and severity of the learning disabilities, but also on whether there are associated deficits. 25 Moreover, it is a lifelong condition and older children may have a higher prevalence rate and increasing trend due to longer exposure to the possibility of evaluation and diagnosis. 7 Nearly all studies have reported a higher prevalence of LD and other developmental disorders in boys than in girls. 26 Studies on gender discrepancies in LD have reported that females tend to have advantages in both verbal working memory and literacy, with better linguistic processing and reading fluency. 27 – 29 Additionally, our findings indicated that non-Hispanic blacks and non-Hispanic whites are more likely to be diagnosed with learning disabilities, with an increasing trend observed among non-Hispanic whites, which is consistent with findings observed in other studies 30 , 31 Previous literature has suggested that limited access to healthcare services and language barriers could possibly account for the lower incidence of LD reported among Hispanic parents. 32 Consistent with other reports, LD is associated with family socioeconomic status. Lower household education and lower family income levels are linked with higher odds of LD. 7 , 9 , 33 Nicole et al. further suggested a connection between low socioeconomic status and diminished cognitive, academic, and behavioural performance in early childhood. 34 , 35 Particularly noteworthy was the observed increasing trend of LD in families with higher levels of education, such as college education or beyond. Although the reasons for this trend remain unclear, it's possible that the high expectations and demands from these parents lead to an over-reporting of LD. Over the 7-year period from 2016 to 2022, our study revealed a significant annual average change in the prevalence of both ever-diagnosed and currently-diagnosed LD. The prevalence of ever-diagnosed LD increased from 7.86–9.45%, and that of current-diagnosed LD from 7.32–8.80%, indicating a 20% total increase in both types. However, such a significant rise was not observed in other studies pertaining to LD. 12 , 23 Over the past twenty-five years, the prevalence of LD, according to NHIS data, was recorded at 7.66% from 1997 to 2008, 36 7.74% from 2009 to 2017, 23 and 7.6% from 2019 to 2020, 37 respectively. The discrepancy observed between learning disabilities estimates derived from NSCH data and those from NHIS data may partially stem from differences in data collection methods and the sample size between the two databases. 38 Non-etiological factors may be partly responsible for the increase in the prevalence of LD in this study. We estimated the prevalence of parent-reported LD using data from the NSCH; however, since the questionnaire only inquired about ‘‘learning disabilities’’ without specifying which disorders were regarded as LD, parents could have comprehended this term to describe an extensive range of learning difficulties. 39 , 40 The expansion of medical education and a growing emphasis on learning disabilities has led to an increased sensitivity of doctors towards diagnosing these conditions, as well as changes in the acceptance of the diagnosis of learning disabilities by parents and teachers, which have led to an increase in the prevalence of learning disabilities. 10 , 13 The availability of resources and the presence of other developmental disabilities can also significantly impact the number and prevalence of LD. 41 As the prevalence of disorders such as Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) increases, so does the prevalence of LD due to the comorbidity of LD and ASD/ADHD. 40,42 Although the pathogenesis of learning disabilities is currently unclear, previous studies have suggested that genetic, neuropsychological, and environmental factors are contributory. 43 , 44 Certain heritable disorders even approach 100% penetrance, however, the clinical presentation can still be influenced by environmental risk factors. 45 In terms of environmental triggers, prenatal and perinatal risk factors, including prematurity, low birthweight, maternal smoking, and maternal alcohol abuse during pregnancy, have been associated with LD risk. 7 , 46 – 48 Stein et al. conducted an analysis of NHIS data involving 7817 children and discovered that those with moderately low birthweight were significantly more likely to be diagnosed with a learning disability compared to their normal birthweight counterparts. 49 Dietary behaviors have also been proposed to play a role in the increases in LD, exemplified by a study that found a high intake of sweetened desserts, fried food, and salt was associated with more learning disability. 50 Many proven or potential environmental biological factors are associated with learning disability, such as cadmium, phthalates, and lead. 51 , 52 A study using data from NHANES showed that children in the highest quartile of urinary cadmium had significantly higher odds of LD when compared with those in the lowest quartile. 51 , 53 Children with learning disabilities may experience social exclusion, bullying, poor self-image, and underachievement. 54 Research has confirmed that learning disabilities are lifelong; 9 this presents numerous challenges in various functional areas that adults with learning disabilities must adapt to, such as employment, family, social and emotional health, daily living routines, community life, and recreational and leisure activities. 55 Meanwhile, it is noteworthy that a family's level of education bears an impact on their economic status. Children living in poverty tend to score lower on standardized tests of academic achievement, a trend that continues into adulthood, subsequently leading to lower wages and incomes. 35 In addition, the economic impact of increased LD prevalence on families, schools and the healthcare system is significant. 56 – 58 Forsyth et al. using data from the National Audit Commission and the Department of Health, reported widespread discrepancy from the median spend/ burden ratio standing at £10260 per person with learning disability. 59 According to a study conducted in Mumbai, the direct, indirect, and intangible costs associated with specific learning disability amounted to Indian Rupees (INR) 5936053, 29261220, and 42295000, respectively. 60 In the US, it's reported that over half of the students receiving special education services do so due to learning disabilities.. 11 Given the significant economic and social costs associated with LD, it is crucially important to continuously monitor the prevalence and characteristics of children diagnosed with these conditions. Strengths and Limitations The main advantage of this study is the use of a nationally representative sample of the US population, which allows us to generalize our findings to a wider population. Furthermore, by employing a series of nationwide, population-based, cross-sectional surveys, not only were we able to examine the secular trends in the prevalence of learning disabilities over a period of 7 years, but it also facilitated an assessment of the disparities in this prevalence relative to various population characteristics. This study has several limitations. First, the cross-sectional design of the NSCH does not permit the identification of how specific factors may influence the diagnosis of LD. Second, the reliance on parental reports for the diagnosis of LD could potentially invite inaccuracies due to misreporting and recall bias. Conclusions This study presents a national and state-level overview of the epidemiology and characteristics of school-aged children with parent-reported diagnoses of LD from 2016 to 2022. We found a significant increase in the prevalence of both ever and current LD in US children over this period. Given the shifting trends in LD and the considerable impact it has on children, continual monitoring of its national prevalence is imperative. Declarations Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Any errors or omissions are the responsibility of the authors. Competing interests The authors declare no competing interests. Author Contribution Dr. W.Y. has full access to all of the data in this study and assumes responsibility for study supervision. Concept and design: W.Y., Y.Q., Acquisition, analysis, or interpretation of data: W.Y., C.X., Y.L., H.Y., Drafting of the manuscript: C.X., Y.L., Critical revision of the manuscript for important intellectual content: All authors, Statistical analysis: W.Y., C.X., Y.L., H.Y. Acknowledgement The data used in this study were obtained from the NSCH, a public database provided by the U.S. Centers for Disease Control and Prevention (CDC). The authors would like to acknowledge the support from all the team members and all staff of the CDC. This research was funded by the National Natural Science Foundation of China (Grant No. 81973063). Data Availability The original contributions presented in the study are publicly available. The datasets analyzed during current study are available at NSCH online website: https://www.census.gov/programs-surveys/nsch.html. References Hammill, D. D. On defining learning disabilities: an emerging consensus. J Learn Disabil 23, 74–84 (1990). Lyon, G. R. 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Association between screen time and developmental and behavioral problems among children in the United States: evidence from 2018 to 2020 NSCH. J Psychiatr Res 161, 140–149 (2023). Zablotsky, B. et al. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017. Pediatrics 144, e20190811 (2019). Yang, W. et al. Association of Anemia with Neurodevelopmental Disorders in a Nationally Representative Sample of US Children. J Pediatr 228, 183–189.e2 (2021). Shapiro, B. K. & Gallico, R. P. Learning disabilities. Pediatr Clin North Am 40, 491–505 (1993). Boyle, C. A. et al. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 127, 1034–1042 (2011). Bölte, S. et al. Sex and gender in neurodevelopmental conditions. Nat Rev Neurol 19, 136–159 (2023). Landerl, K. & Moll, K. Comorbidity of learning disorders: prevalence and familial transmission. J Child Psychol Psychiatry 51, 287–294 (2010). Krafnick, A. J. & Evans, T. M. Neurobiological Sex Differences in Developmental Dyslexia. Front Psychol 9, 2669 (2018). Zablotsky, B. & Alford, J. M. Racial and Ethnic Differences in the Prevalence of Attention-deficit/Hyperactivity Disorder and Learning Disabilities Among U.S. Children Aged 3–17 Years. NCHS Data Brief 1–8 (2020). Shifrer, D., Muller, C. & Callahan, R. Disproportionality and learning disabilities: parsing apart race, socioeconomic status, and language. J Learn Disabil 44, 246–257 (2011). Stevens, J., Harman, J. S. & Kelleher, K. J. Ethnic and regional differences in primary care visits for attention-deficit hyperactivity disorder. J Dev Behav Pediatr 25, 318–325 (2004). Pastor, P. N. & Reuben, C. A. Attention Deficit Disorder and Learning Disability: United States, 1997-98. Vital Health Stat 10 1–12 (2002). Black, M. M. et al. Early childhood development coming of age: science through the life course. Lancet 389, 77–90 (2017). Hair, N. L., Hanson, J. L., Wolfe, B. L. & Pollak, S. D. Association of Child Poverty, Brain Development, and Academic Achievement. JAMA Pediatr 169, 822–829 (2015). Boyle, C. A. et al. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 127, 1034–1042 (2011). Yang, Y. et al. Prevalence of neurodevelopmental disorders among US children and adolescents in 2019 and 2020. Front Psychol 13, 997648 (2022). Mental health in the United States: parental report of diagnosed autism in children aged 4–17 years–United States, 2003–2004. MMWR. Morbidity and mortality weekly report 55, (2006). Pc, P. Prevalence of LD From Parental and Professional Perspectives: A Comparison of the Data From the National Survey of Children’s Health and the Office of Special Education Programs’ Reports to Congress. Journal of learning disabilities 50, (2017). Pastor, P. N. & Reuben, C. A. Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004–2006. Vital Health Stat 10 1–14 (2008). Pratt, H. D. & Patel, D. R. Learning disorders in children and adolescents. Prim Care 34, 361–374; abstract viii (2007). Margari, L. et al. Neuropsychopathological comorbidities in learning disorders. BMC Neurol 13, 198 (2013). Plomin, R. & Kovas, Y. Generalist genes and learning disabilities. Psychol Bull 131, 592–617 (2005). Fletcher, J. M. & Grigorenko, E. L. Neuropsychology of Learning Disabilities: The Past and the Future. J Int Neuropsychol Soc 23, 930–940 (2017). Hornig, M. & Lipkin, W. I. Infectious and immune factors in the pathogenesis of neurodevelopmental disorders: epidemiology, hypotheses, and animal models. Ment Retard Dev Disabil Res Rev 7, 200–210 (2001). Harris, M. N. et al. ADHD and learning disabilities in former late preterm infants: a population-based birth cohort. Pediatrics 132, e630-636 (2013). Batstra, L., Hadders-Algra, M. & Neeleman, J. Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort. Early Hum Dev 75, 21–33 (2003). Olson, H. C. et al. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. J Am Acad Child Adolesc Psychiatry 36, 1187–1194 (1997). Stein, R. E. K., Siegel, M. J. & Bauman, L. J. Are children of moderately low birth weight at increased risk for poor health? A new look at an old question. Pediatrics 118, 217–223 (2006). Park, S. et al. Association between dietary behaviors and attention-deficit/hyperactivity disorder and learning disabilities in school-aged children. Psychiatry Res 198, 468–476 (2012). Chopra, V., Harley, K., Lahiff, M. & Eskenazi, B. Association between phthalates and attention deficit disorder and learning disability in U.S. children, 6–15 years. Environ Res 128, 64–69 (2014). Geier, D. A., Kern, J. K. & Geier, M. R. Blood Lead Levels and Learning Disabilities: A Cross-Sectional Study of the 2003–2004 National Health and Nutrition Examination Survey (NHANES). Int J Environ Res Public Health 14, 1202 (2017). Ciesielski, T. et al. Cadmium exposure and neurodevelopmental outcomes in U.S. children. Environ Health Perspect 120, 758–763 (2012). Bishop, T. W. Mental Disorders and Learning Disabilities in Children and Adolescents: Learning Disabilities. FP Essent 475, 18–22 (2018). Gerber, P. J. The impact of learning disabilities on adulthood: a review of the evidenced-based literature for research and practice in adult education. J Learn Disabil 45, 31–46 (2012). Lardieri, L. A., Blacher, J. & Swanson, H. L. Sibling Relationships and Parent Stress in Families of Children with and without Learning Disabilities. Learning Disability Quarterly 23, 105–116 (2000). Khasawneh, M. A. S. K. Work pressures among teachers of learning disabilities in English language from their point of view. Journal of Asian Multicultural Research for Educational Study 2, 15–23 (2021). Smith, K., Shah, A., Wright, K. & Lewis, G. The prevalence and costs of psychiatric disorders and learning disabilities. Br J Psychiatry 166, 9–18 (1995). Forsyth, B. & Winterbottom, P. Beds, budgets and burdens: learning disability expenditure v. workload across English health authorities. Comparative review. Br J Psychiatry 181, 200–207 (2002). Karande, S., D’souza, S., Gogtay, N., Shiledar, M. & Sholapurwala, R. Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 65, 152–159 (2019). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":772866,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eWeighted prevalence estimates of parent-reported ever learning disability (LD) among children aged 6–17 years by state – United States, 2016-2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3curLD.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4749516/v1/2493ba4a037fed710f70e674.jpg"},{"id":62632556,"identity":"8fbf0b8a-e157-4a1b-9f3d-743081937e9f","added_by":"auto","created_at":"2024-08-16 16:13:07","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":756377,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eWeighted prevalence estimates of parent-reported current learning disability (LD) among children aged 6–17 years by state – United States, 2016-2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2everLD.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4749516/v1/bf98674df3e2a22a8274f294.jpg"},{"id":62632554,"identity":"0e06c3b9-484e-4991-9181-529ab8a5f514","added_by":"auto","created_at":"2024-08-16 16:13:01","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":532135,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends in the Prevalence of Ever Learning Disability (LD), 2016-2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure4trend.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4749516/v1/876d51f3f7738cf615255111.jpg"},{"id":68421299,"identity":"2acf0621-fb73-4c99-b084-164fd09ce238","added_by":"auto","created_at":"2024-11-07 06:09:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3546768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4749516/v1/5f805103-242d-4100-99d6-f7e9e49de880.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rising Prevalence of Parent-Reported Learning Disabilities among U.S. Children and Adolescents Aged 6-17 years: NSCH, 2016-2022","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLearning disability (LD) is a generic term used to describe a group of heterogeneous disorders manifested by significant difficulties in listening, speaking, reading, writing, thinking, mathematics, or social skills.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e These disabilities are specific and life-long, potentially leading to long-term consequences in education, social interaction, and economic performance.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Compared with their peers without LD, children with LD often exhibit a higher vulnerability to mental and behavioral disorders, positing a continuous need for support and interventions throughout their lives.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOver the past decades, learning disabilities have emerged as a major health concern for school-aged children in the United States.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Literature reports indicated that the prevalence of LD among children varies from 8.2\u0026ndash;9.7%, according to data extracted from the National Health Interview Survey (NHIS) between 1999 to 2006, and the National Survey of Children\u0026rsquo;s Health in 2003.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Both educators and clinicians have observed an increase in the number of children with learning disabilities.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In a clinician reported study, the prevalence of specific developmental delays, which include learning disabilities, speech, and language delays, surged by 40% from 1979 (1.5%) to 1996 (2.1%) among children aged between 4 to 15 years.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Nevertheless, a study indicated no significant annual average change in LD from the NHIS in the United States from 1997 to 2021.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e The reported prevalence of learning disabilities varies substantially across studies, often due to the barriers to identifying learning disabilities\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and the heterogeneity of definitions, instruments used, and study designs.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Despite the reliability of NHIS studies, further scrutiny of more recent data is warranted to derive deeper understanding of trends in learning disability prevalence.\u003c/p\u003e \u003cp\u003eThe National Survey of Children\u0026rsquo;s Health (NSCH) is a significant survey project that aims to investigate children\u0026rsquo;s health and well-being. Since 2016, the NSCH has adopted the redesigned surveys, moving from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e According to the topical questionnaire, children with special health care needs were more likely to be selected, bolstering the sample size of this targeted population.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Therefore, it is worth conducting health surveys to monitor the number and characteristics of children diagnosed with learning disabilities through NSCH data. This is crucial for the formulation of educational policies, early intervention and support, and the improvement of the learning environment for children.\u003c/p\u003e \u003cp\u003eIn April 2024, The Maternal and Child Health Bureau in conjunction with the Census Bureau revised the imputation and weighting by race and ethnicity for the 2016\u0026ndash;2021 NSCH. Following this revision, we have utilized the updated NSCH data to analyze nationally representative information in this study. Our objective is to estimate the most recent prevalence of LD diagnosis among U.S. children and adolescents at both national and state levels, and to inspect the 7-year trends in these estimates from 2016 to 2022.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Source\u003c/h2\u003e \u003cp\u003eData for this study were obtained from the NSCH conducted between 2016 and 2022. The NSCH is a cross-sectional survey was conducted via mail and online by the Data Resource Center (DRC) to collect health information on the welfare of children and adolescents aged 0\u0026ndash;17 years in the US.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The survey encompasses non-institutionalized children who live with their families or guardians and excludes those residing in institutional settings like orphanages or group homes. Survey respondents were parents or caregivers with at least one child aged 0\u0026ndash;17 years who resided in the same household during the entire interview. The funding and oversight for the NSCH are provided by the Health Resources and Services Administration\u0026rsquo;s Maternal and Child Health Bureau.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Ethical approval for all survey procedures is obtained from the National Center for Health Statistics Research Ethics Review Board. Written consent is obtained through electronic submission or paper mailing, and it is returned to the US Census Bureau.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The Guangdong Pharmaceutical University Academic Review Board determined the present study was exempt from approval because of the use of de-identified data. The NSCH data collection encompasses all 50 states and the District of Columbia, providing a comprehensive representative of the population in the US.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe NSCH collected data on a variety of health topics through household interviews. For each family in the household, one child under 18 years old was randomly selected as a sample. Information for this child was collected by interviewing an adult family who was knowledgeable about the child's health. From 2016 to 2022, the weighted Topical Completion Rate ranged from 30.6\u0026ndash;30.9%, the weighted Interview Completion Rate ranged from 69.7\u0026ndash;78.5% and the weighted Overall Response Rate ranged from 37.4\u0026ndash;39.1%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003e Parents or caregivers were asked if a doctor, other health care provider or educator had ever told them that their child had \u0026ldquo;Learning Disability\u0026rdquo; (Ever LD). Parents or caregivers who responded \u0026ldquo;Yes\u0026rdquo; were subsequently asked if their child currently has \u0026ldquo;Learning Disability\u0026rdquo; (Current LD).\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Because learning disabilities are not diagnosed until children enter school, analyses for this study were limited to 187805 children aged 6 to 17 years and excluded children \u0026lt;6 years (n\u0026thinsp;=\u0026thinsp;90006).\u003csup\u003e20\u003c/sup\u003e Besides, 1735 children were excluded because of missing data on ever diagnosis information (n\u0026thinsp;=\u0026thinsp;650), current diagnosis information (n\u0026thinsp;=\u0026thinsp;210) and highest parental education (n\u0026thinsp;=\u0026thinsp;875) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cp\u003eThe outcome variable for this analysis were \u0026ldquo;Ever LD\u0026rdquo; and \u0026ldquo;Current LD.\u0026rdquo; Information on sex, race/ethnicity, family income and highest education of family members were collected using a standardized questionnaire during the interview. The study divided the race/ethnicity into four groups, Hispanic, non-Hispanic whites, non-Hispanic blacks, and other based on the 1997 Office of Management and Budget Standards. The highest educational level of family members was categorized as less than high school, high school, and college or higher. Family income factors included in the analysis were Federal poverty level (FPL), grouped as 0\u0026ndash;99%FPL, 100\u0026ndash;199%FPL, 200\u0026ndash;399%FPL, and 400%FPL or above.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFor this study, analyses were limited to 187805 children and adolescents aged 6\u0026ndash;17 years. Weighted estimates were applied according to the NSCH Analytic Guidelines.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Population characteristics were shown according to ever and current LD prevalence with 95% confidence interval (CI). Rao-Scott chi-square tests were employed to compare differences of categorical variables. Logistic regression model was used to estimate trends in the prevalence over time, which included the survey year as a continuous variable and adjusted for age, sex, and race/ethnicity, family income, and highest education of family members. All of the statistical analyses were performed using SAS Software, version 9.4. All estimates are weighted based on the complex sampling design of NSCH. The 2 sided statistical significance level was set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Parent-Reported LD in US Children and Adolescents, 2016\u0026ndash;2022\u003c/h2\u003e \u003cp\u003eThis study included 187805 children and adolescents aged 6\u0026ndash;17 years (97123 boys [51.71%], 90682 girls [48.29%], 24184 Hispanic [12.88%], 127277 non-Hispanic white [67.77%], 12491 non-Hispanic black [6.65%], 23853 other race/ ethnicity [12.70%]) in 2016\u0026ndash;2022. Of the eligible children, 17379 were reported to have ever been diagnosed with LD and the weighted prevalence was 8.80% (95%CI, 8.52\u0026ndash;9.08). Among those who had ever been diagnosed as having LD, 16221 were reported to have currently been diagnosed with LD and the weighted prevalence was 8.20% (95%CI, 7.93\u0026ndash;8.48) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The state with the highest prevalence, New Hampshire (12.61% of ever-diagnosed LD and 11.65% of current LD), had twice that of the state with the lowest prevalence, Utah (6.07% of ever-diagnosed LD and 5.70% of current LD) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of Diagnosed LD in US Children and Adolescents Aged 6\u0026ndash;17 Years, 2016\u0026ndash;2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eParticipants, No.(%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eEver LD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eCurrent LD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants, No. (%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence, %\u003c/p\u003e \u003cp\u003e(95% CI)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eParticipants, No. (%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePrevalence, %\u003c/p\u003e \u003cp\u003e(95% CI)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.80 (8.52\u0026ndash;9.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.20 (7.93\u0026ndash;8.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eAge, year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81647 (43.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6600 (37.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.89 (7.48\u0026ndash;8.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6305 (38.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.50 (7.09\u0026ndash;7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106158 (56.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10779 (62.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.70 (9.31\u0026ndash;10.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9916 (61.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.89 (8.53\u0026ndash;9.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97123 (51.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10944 (62.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.72 (10.29\u0026ndash;11.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10194 (62.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.93 (9.52\u0026ndash;10.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90682 (48.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6435 (37.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.80 (6.43\u0026ndash;7.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6027 (37.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.40 (6.04\u0026ndash;6.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eRace/ethnicity\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24184 (12.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2238 (12.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.23 (7.49\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2071 (12.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.57 (6.86\u0026ndash;8.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127277 (67.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11793 (67.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.72 (8.44\u0026ndash;9.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11023 (68.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.19 (7.91\u0026ndash;8.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12491 (6.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1480 (8.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.37 (10.43\u0026ndash;12.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1381 (8.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.50 (9.59\u0026ndash;11.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23853 (12.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1868 (10.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.24 (6.59\u0026ndash;7.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1746 (10.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.85 (6.21\u0026ndash;7.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eHighest educational level of family members\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5167 (2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e557 (3.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.42 (7.13\u0026ndash;9.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e524 (3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.84 (6.6.-9.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25765 (13.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3155 (18.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.44 (10.63\u0026ndash;12.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2965 (18.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.75 (9.96\u0026ndash;11.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e156873 (83.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13667 (78.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.11 (7.84\u0026ndash;8.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12732 (78.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.53 (7.27\u0026ndash;7.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eFamily income, % FPL\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22357 (11.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3125 (17.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.12 (11.23-13.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2952 (18.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.30 (10.45\u0026ndash;12.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100\u0026ndash;199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30549 (16.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3504 (20.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.27 (9.55\u0026ndash;10.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3266 (20.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.55 (8.85\u0026ndash;10.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e200\u0026ndash;399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56752 (30.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5096 (29.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.95 (7.49\u0026ndash;8.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4746 (29.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.37 (6.93\u0026ndash;7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78147 (41.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5654 (32.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.52 (6.20\u0026ndash;6.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5257 (32.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.12 (5.80\u0026ndash;6.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviation: LD\u0026thinsp;=\u0026thinsp;Learning Disability; FPL\u0026thinsp;=\u0026thinsp;Federal Poverty Level.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e The numbers of participants were unweighted.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e Prevalence estimates were weighted.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ec\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e value for overall differences in prevalence by stratum.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ed\u003c/sup\u003e Race and Hispanic ethnicity were self-reported and classified based on 1997 US Office of Management and Budget standards. Other races and ethnicities included non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, non-Hispanic Native Hawaiian and Other Pacific Islander, and non-Hispanic multiple race.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ee\u003c/sup\u003e The family income-to-poverty ratio is the total family income divided by the poverty threshold.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe found that age, sex, race/ethnicity, family income and highest education of family members were significant differences in both Ever LD and Current LD.\u003c/p\u003e \u003cp\u003eThe weighted prevalence of LD was slightly higher in children aged 12\u0026ndash;17 years (Ever LD, 9.70%, 95%CI, 9.31\u0026ndash;10.09; Current LD, 8.89%, 95%CI, 8.53\u0026ndash;9.26) than in children aged 6\u0026ndash;11 years (Ever LD, 7.89%, 95%CI, 7.48\u0026ndash;8.30; Current LD, 7.50%, 95%CI, 7.09\u0026ndash;7.90). In the sex group, the weighted prevalence of LD was higher in boys (Ever LD, 10.72%, 95%CI, 10.29\u0026ndash;11.14; Current LD, 9.93%, 95%CI, 9.52\u0026ndash;10.34) than in girls (Ever LD, 6.80%, 95%CI, 6.43\u0026ndash;7.17; Current LD, 6.40%, 95%CI, 6.04\u0026ndash;6.76). For race/ethnicity and level of family education, we found that the weighted prevalence of LD was highest among non-Hispanic blacks (Ever LD, 11.37%, 95%CI, 10.43\u0026ndash;12.32; Current LD, 10.50%, 95%CI, 9.59\u0026ndash;11.40) and those with a high school education (Ever LD, 11.44%, 95%CI, 10.63\u0026ndash;12.24; Current LD, 10.75%, 95%CI, 9.96\u0026ndash;11.53). The weighted ever and current LD prevalence increase with the decrease of family economic level (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eTrends in Ever and Current LD in US Children and Adolescents, 2016\u0026ndash;2022\u003c/h2\u003e \u003cp\u003eThe weighted prevalence of Ever LD and Current LD in US children and adolescents aged 6 to 17 years were 7.86% (95%CI, 7.25\u0026ndash;8.46) and 7.32% (95%CI, 6.73\u0026ndash;7.91) in 2016, 9.08% (95%CI, 7.99\u0026ndash;10.16) and 8.69% (95%CI, 7.61\u0026ndash;9.76) in 2017, 8.60% (95%CI, 7.84\u0026ndash;9.36) and 7.98% (95%CI, 7.24\u0026ndash;8.71) in 2018, 8.11% (95%CI, 7.42\u0026ndash;8.80) and 7.37% (95%CI, 6.74-8.00) in 2019, 9.22% (95%CI, 8.53\u0026ndash;9.92) and 8.71% (95%CI, 8.02\u0026ndash;9.39) in 2020, 9.25% (95%CI, 8.58\u0026ndash;9.92) and 8.53% (95%CI, 7.90\u0026ndash;9.15) in 2021, 9.45% (95%CI, 8.86\u0026ndash;10.05) and 8.80% (95%CI, 8.22\u0026ndash;9.38) in 2022, respectively (\u003cem\u003eP for trend\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01). We found a significant average annual change in aged 12\u0026ndash;17 years, female, non-Hispanic white, a college or higher education, and family income of 200%FPL or above in the prevalence of both Ever LD and Current LD (\u003cem\u003eP for trend\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTrends in the Prevalence of Ever Diagnosed LD in US Children and Adolescents Aged 6 to 17 Years, 2016\u0026ndash;2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003ePrevalence of Ever LD, % (95% CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for trend\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.86\u003c/p\u003e \u003cp\u003e(7.25\u0026ndash;8.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.08\u003c/p\u003e \u003cp\u003e(7.99\u0026ndash;10.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.60\u003c/p\u003e \u003cp\u003e(7.84\u0026ndash;9.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.11\u003c/p\u003e \u003cp\u003e(7.42\u0026ndash;8.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.22\u003c/p\u003e \u003cp\u003e(8.53\u0026ndash;9.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.25\u003c/p\u003e \u003cp\u003e(8.58\u0026ndash;9.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.45\u003c/p\u003e \u003cp\u003e(8.86\u0026ndash;10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eAge, year\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.94\u003c/p\u003e \u003cp\u003e(6.10\u0026ndash;7.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.97\u003c/p\u003e \u003cp\u003e(7.23\u0026ndash;10.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.36\u003c/p\u003e \u003cp\u003e(7.23\u0026ndash;9.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.02\u003c/p\u003e \u003cp\u003e(6.09\u0026ndash;7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.41\u003c/p\u003e \u003cp\u003e(6.56\u0026ndash;8.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.05\u003c/p\u003e \u003cp\u003e(7.17\u0026ndash;8.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.41\u003c/p\u003e \u003cp\u003e(7.54\u0026ndash;9.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.79\u003c/p\u003e \u003cp\u003e(7.91\u0026ndash;9.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.18\u003c/p\u003e \u003cp\u003e(7.89\u0026ndash;10.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.84\u003c/p\u003e \u003cp\u003e(7.83\u0026ndash;9.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.19\u003c/p\u003e \u003cp\u003e(8.17\u0026ndash;10.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.96\u003c/p\u003e \u003cp\u003e(9.89\u0026ndash;12.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.41\u003c/p\u003e \u003cp\u003e(9.40-11.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.43\u003c/p\u003e \u003cp\u003e(9.60-11.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.55\u003c/p\u003e \u003cp\u003e(8.72\u0026ndash;10.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.28\u003c/p\u003e \u003cp\u003e(9.68\u0026ndash;12.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.57\u003c/p\u003e \u003cp\u003e(9.40-11.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.14\u003c/p\u003e \u003cp\u003e(9.10-11.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.21\u003c/p\u003e \u003cp\u003e(10.13\u0026ndash;12.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.50\u003c/p\u003e \u003cp\u003e(10.41\u0026ndash;12.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.74\u003c/p\u003e \u003cp\u003e(9.92\u0026ndash;11.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003cp\u003e(5.21\u0026ndash;6.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.77\u003c/p\u003e \u003cp\u003e(5.32\u0026ndash;8.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003cp\u003e(5.60\u0026ndash;7.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003cp\u003e(5.12\u0026ndash;6.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.15\u003c/p\u003e \u003cp\u003e(6.30\u0026ndash;8.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003cp\u003e(6.15\u0026ndash;7.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.10\u003c/p\u003e \u003cp\u003e(7.23\u0026ndash;8.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eRace/ethnicity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.88\u003c/p\u003e \u003cp\u003e(5.27\u0026ndash;8.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.02\u003c/p\u003e \u003cp\u003e(6.95\u0026ndash;13.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003cp\u003e(6.61\u0026ndash;10.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.22\u003c/p\u003e \u003cp\u003e(5.54\u0026ndash;8.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.12\u003c/p\u003e \u003cp\u003e(6.41\u0026ndash;9.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.36\u003c/p\u003e \u003cp\u003e(6.56\u0026ndash;10.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.35\u003c/p\u003e \u003cp\u003e(6.95\u0026ndash;9.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.14\u003c/p\u003e \u003cp\u003e(7.48\u0026ndash;8.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.99\u003c/p\u003e \u003cp\u003e(7.12\u0026ndash;8.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.27\u003c/p\u003e \u003cp\u003e(7.51\u0026ndash;9.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003cp\u003e(7.53\u0026ndash;9.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.20\u003c/p\u003e \u003cp\u003e(8.43\u0026ndash;9.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.51\u003c/p\u003e \u003cp\u003e(8.80-10.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.67\u003c/p\u003e \u003cp\u003e(8.95\u0026ndash;10.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.34\u003c/p\u003e \u003cp\u003e(8.42\u0026ndash;12.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.19\u003c/p\u003e \u003cp\u003e(8.59\u0026ndash;15.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.83\u003c/p\u003e \u003cp\u003e(8.28\u0026ndash;13.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.95\u003c/p\u003e \u003cp\u003e(7.69\u0026ndash;12.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.68\u003c/p\u003e \u003cp\u003e(10.35\u0026ndash;15.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.30\u003c/p\u003e \u003cp\u003e(9.26\u0026ndash;13.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.27\u003c/p\u003e \u003cp\u003e(10.15\u0026ndash;14.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.47\u003c/p\u003e \u003cp\u003e(4.30\u0026ndash;6.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.54\u003c/p\u003e \u003cp\u003e(4.67\u0026ndash;10.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.16\u003c/p\u003e \u003cp\u003e(5.44\u0026ndash;8.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003cp\u003e(5.36\u0026ndash;8.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.64\u003c/p\u003e \u003cp\u003e(5.97\u0026ndash;9.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.58\u003c/p\u003e \u003cp\u003e(6.01\u0026ndash;9.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.05\u003c/p\u003e \u003cp\u003e(6.81\u0026ndash;9.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eHighest educational level of family members\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.45\u003c/p\u003e \u003cp\u003e(5.60\u0026ndash;11.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.35\u003c/p\u003e \u003cp\u003e(6.53\u0026ndash;18.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.09\u003c/p\u003e \u003cp\u003e(4.36\u0026ndash;9.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.05\u003c/p\u003e \u003cp\u003e(4.56\u0026ndash;9.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.70\u003c/p\u003e \u003cp\u003e(6.56\u0026ndash;12.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003cp\u003e(3.11\u0026ndash;8.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.47\u003c/p\u003e \u003cp\u003e(6.10-10.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.14\u003c/p\u003e \u003cp\u003e(8.43\u0026ndash;11.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.61\u003c/p\u003e \u003cp\u003e(9.59\u0026ndash;15.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.80\u003c/p\u003e \u003cp\u003e(9.68\u0026ndash;13.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.83\u003c/p\u003e \u003cp\u003e(8.79\u0026ndash;12.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.18\u003c/p\u003e \u003cp\u003e(9.26\u0026ndash;13.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.90\u003c/p\u003e \u003cp\u003e(9.90\u0026ndash;13.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.62\u003c/p\u003e \u003cp\u003e(9.87\u0026ndash;13.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.07\u003c/p\u003e \u003cp\u003e(6.51\u0026ndash;7.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.55\u003c/p\u003e \u003cp\u003e(6.63\u0026ndash;8.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.96\u003c/p\u003e \u003cp\u003e(7.15\u0026ndash;8.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.51\u003c/p\u003e \u003cp\u003e(6.81\u0026ndash;8.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003cp\u003e(7.90\u0026ndash;9.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.00\u003c/p\u003e \u003cp\u003e(8.33\u0026ndash;9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.01\u003c/p\u003e \u003cp\u003e(8.39\u0026ndash;9.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eFamily income, % FPL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.93\u003c/p\u003e \u003cp\u003e(9.07\u0026ndash;12.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.35\u003c/p\u003e \u003cp\u003e(10.68\u0026ndash;18.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.90\u003c/p\u003e \u003cp\u003e(8.92\u0026ndash;12.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.24\u003c/p\u003e \u003cp\u003e(9.85\u0026ndash;14.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.16\u003c/p\u003e \u003cp\u003e(10.18\u0026ndash;14.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.24\u003c/p\u003e \u003cp\u003e(10.25\u0026ndash;14.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.97\u003c/p\u003e \u003cp\u003e(10.43\u0026ndash;13.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100\u0026ndash;199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.88\u003c/p\u003e \u003cp\u003e(7.33\u0026ndash;10.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.18\u003c/p\u003e \u003cp\u003e(8.44\u0026ndash;13.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.46\u003c/p\u003e \u003cp\u003e(8.47\u0026ndash;12.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.24\u003c/p\u003e \u003cp\u003e(7.64\u0026ndash;10.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.54\u003c/p\u003e \u003cp\u003e(8.92\u0026ndash;12.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.89\u003c/p\u003e \u003cp\u003e(9.07\u0026ndash;12.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.73\u003c/p\u003e \u003cp\u003e(9.15\u0026ndash;12.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e200\u0026ndash;399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.87\u003c/p\u003e \u003cp\u003e(5.99\u0026ndash;7.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.15\u003c/p\u003e \u003cp\u003e(5.82\u0026ndash;8.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.92\u003c/p\u003e \u003cp\u003e(6.47\u0026ndash;9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.02\u003c/p\u003e \u003cp\u003e(6.01\u0026ndash;8.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.18\u003c/p\u003e \u003cp\u003e(7.79\u0026ndash;10.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.85\u003c/p\u003e \u003cp\u003e(6.87\u0026ndash;8.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.44\u003c/p\u003e \u003cp\u003e(8.23\u0026ndash;10.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.81\u003c/p\u003e \u003cp\u003e(5.15\u0026ndash;6.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.79\u003c/p\u003e \u003cp\u003e(4.77\u0026ndash;6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.40\u003c/p\u003e \u003cp\u003e(5.52\u0026ndash;7.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.93\u003c/p\u003e \u003cp\u003e(5.04\u0026ndash;6.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.60\u003c/p\u003e \u003cp\u003e(5.79\u0026ndash;7.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.66\u003c/p\u003e \u003cp\u003e(6.72\u0026ndash;8.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.32\u003c/p\u003e \u003cp\u003e(6.57\u0026ndash;8.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e Prevalence estimates were weighted.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e values for trends were calculated using weighted logistic regression models, which included survey year as a continuous variable and adjusted for age, sex, race/ethnicity, education and family income to poverty ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTrends in the Prevalence of Current Diagnosed LD in US Children and Adolescents Aged 6 to 17 Years, 2016\u0026ndash;2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003ePrevalence of Current LD, % (95% CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for trend\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.32\u003c/p\u003e \u003cp\u003e(6.73\u0026ndash;7.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.69\u003c/p\u003e \u003cp\u003e(7.61\u0026ndash;9.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.98\u003c/p\u003e \u003cp\u003e(7.24\u0026ndash;8.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.37\u003c/p\u003e \u003cp\u003e(6.74-8.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.71\u003c/p\u003e \u003cp\u003e(8.02\u0026ndash;9.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.53\u003c/p\u003e \u003cp\u003e(7.90\u0026ndash;9.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.80\u003c/p\u003e \u003cp\u003e(8.22\u0026ndash;9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.54\u003c/p\u003e \u003cp\u003e(5.74\u0026ndash;7.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.79\u003c/p\u003e \u003cp\u003e(7.06\u0026ndash;10.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.82\u003c/p\u003e \u003cp\u003e(6.72\u0026ndash;8.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.62\u003c/p\u003e \u003cp\u003e(5.73\u0026ndash;7.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.00\u003c/p\u003e \u003cp\u003e(6.16\u0026ndash;7.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.57\u003c/p\u003e \u003cp\u003e(6.72\u0026ndash;8.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.08\u003c/p\u003e \u003cp\u003e(7.22\u0026ndash;8.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.10\u003c/p\u003e \u003cp\u003e(7.24\u0026ndash;8.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003cp\u003e(7.30\u0026ndash;9.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.13\u003c/p\u003e \u003cp\u003e(7.16\u0026ndash;9.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.611\u003c/p\u003e \u003cp\u003e(7.21-9.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.35\u003c/p\u003e \u003cp\u003e(9.29\u0026ndash;11.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.44\u003c/p\u003e \u003cp\u003e(8.54\u0026ndash;10.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.48\u003c/p\u003e \u003cp\u003e(8.70-10.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.94\u003c/p\u003e \u003cp\u003e(8.14\u0026ndash;9.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.81\u003c/p\u003e \u003cp\u003e(9.22\u0026ndash;12.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.73\u003c/p\u003e \u003cp\u003e(8.61\u0026ndash;10.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.12\u003c/p\u003e \u003cp\u003e(8.16\u0026ndash;10.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.61\u003c/p\u003e \u003cp\u003e(9.54\u0026ndash;11.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.44\u003c/p\u003e \u003cp\u003e(9.46\u0026ndash;11.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.83\u003c/p\u003e \u003cp\u003e(9.05\u0026ndash;10.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003cp\u003e(4.76\u0026ndash;6.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.46\u003c/p\u003e \u003cp\u003e(5.03\u0026ndash;7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.14\u003c/p\u003e \u003cp\u003e(5.22\u0026ndash;7.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.54\u003c/p\u003e \u003cp\u003e(4.74\u0026ndash;6.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.72\u003c/p\u003e \u003cp\u003e(5.89\u0026ndash;7.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.52\u003c/p\u003e \u003cp\u003e(5.79\u0026ndash;7.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.73\u003c/p\u003e \u003cp\u003e(6.86\u0026ndash;8.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.48\u003c/p\u003e \u003cp\u003e(4.90\u0026ndash;8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.72\u003c/p\u003e \u003cp\u003e(6.66\u0026ndash;12.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.74\u003c/p\u003e \u003cp\u003e(5.83\u0026ndash;9.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.51\u003c/p\u003e \u003cp\u003e(4.98\u0026ndash;8.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.61\u003c/p\u003e \u003cp\u003e(5.93\u0026ndash;9.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.24\u003c/p\u003e \u003cp\u003e(5.68\u0026ndash;8.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.67\u003c/p\u003e \u003cp\u003e(6.35-9.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.64\u003c/p\u003e \u003cp\u003e(6.99\u0026ndash;8.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.55\u003c/p\u003e \u003cp\u003e(670\u0026thinsp;\u0026minus;\u0026thinsp;8.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.76\u003c/p\u003e \u003cp\u003e(7.01\u0026ndash;8.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.65\u003c/p\u003e \u003cp\u003e(6.90\u0026ndash;8.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.66\u003c/p\u003e \u003cp\u003e(7.91\u0026ndash;9.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.89\u003c/p\u003e \u003cp\u003e(8.20\u0026ndash;9.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.18\u003c/p\u003e \u003cp\u003e(8.47\u0026ndash;9.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.35\u003c/p\u003e \u003cp\u003e(7.62\u0026ndash;11.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.56\u003c/p\u003e \u003cp\u003e(7.99\u0026ndash;15.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.99\u003c/p\u003e \u003cp\u003e(7.60-12.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.54\u003c/p\u003e \u003cp\u003e(6.56\u0026ndash;10.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.15\u003c/p\u003e \u003cp\u003e(9.84\u0026ndash;14.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.73\u003c/p\u003e \u003cp\u003e(8.74\u0026ndash;12.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.10\u003c/p\u003e \u003cp\u003e(9.07\u0026ndash;13.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.98\u003c/p\u003e \u003cp\u003e(3.84\u0026ndash;6.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.48\u003c/p\u003e \u003cp\u003e(4.61\u0026ndash;10.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.86\u003c/p\u003e \u003cp\u003e(5.16\u0026ndash;8.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.65\u003c/p\u003e \u003cp\u003e(5.12\u0026ndash;8.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.18\u003c/p\u003e \u003cp\u003e(5.61\u0026ndash;8.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.16\u003c/p\u003e \u003cp\u003e(5.61\u0026ndash;8.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.39\u003c/p\u003e \u003cp\u003e(6.21\u0026ndash;8.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eHighest educational level of family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.83\u003c/p\u003e \u003cp\u003e(5.12\u0026ndash;10.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.98\u003c/p\u003e \u003cp\u003e(6.18\u0026ndash;17.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003cp\u003e(3.89\u0026ndash;9.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.57\u003c/p\u003e \u003cp\u003e(4.17\u0026ndash;8.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003cp\u003e(6.27\u0026ndash;12.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.48\u003c/p\u003e \u003cp\u003e(2.94\u0026ndash;6.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.99\u003c/p\u003e \u003cp\u003e(5.66\u0026ndash;10.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.68\u003c/p\u003e \u003cp\u003e(7.99\u0026ndash;11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.04\u003c/p\u003e \u003cp\u003e(9.05\u0026ndash;15.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.08\u003c/p\u003e \u003cp\u003e(9.00-13.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.67\u003c/p\u003e \u003cp\u003e(7.78\u0026ndash;11.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.81 (8.90-12.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.03\u003c/p\u003e \u003cp\u003e(9.11\u0026ndash;12.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.91\u003c/p\u003e \u003cp\u003e(9.24\u0026ndash;12.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.52\u003c/p\u003e \u003cp\u003e(5.98\u0026ndash;7.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.21\u003c/p\u003e \u003cp\u003e(6.30\u0026ndash;8.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.35\u003c/p\u003e \u003cp\u003e(6.58\u0026ndash;8.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.85\u003c/p\u003e \u003cp\u003e(6.21\u0026ndash;7.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.99\u003c/p\u003e \u003cp\u003e(7.33\u0026ndash;8.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.39\u003c/p\u003e \u003cp\u003e(7.74\u0026ndash;9.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.35\u003c/p\u003e \u003cp\u003e(7.75\u0026ndash;8.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eFamily income, % FPL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.06\u003c/p\u003e \u003cp\u003e(8.29\u0026ndash;11.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.75\u003c/p\u003e \u003cp\u003e(10.10\u0026ndash;17.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.18\u003c/p\u003e \u003cp\u003e(8.26\u0026ndash;12.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.32\u003c/p\u003e \u003cp\u003e(9.11\u0026ndash;13.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.53\u003c/p\u003e \u003cp\u003e(9.58\u0026ndash;13.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.94\u003c/p\u003e \u003cp\u003e(9.30-12.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.26\u003c/p\u003e \u003cp\u003e(9.76\u0026ndash;12.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100\u0026ndash;199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.15\u003c/p\u003e \u003cp\u003e(6.63\u0026ndash;9.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.78\u003c/p\u003e \u003cp\u003e(8.07\u0026ndash;13.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.76\u003c/p\u003e \u003cp\u003e(7.82\u0026ndash;11.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.41\u003c/p\u003e \u003cp\u003e(6.92\u0026ndash;9.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003cp\u003e(8.39\u0026ndash;11.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.15\u003c/p\u003e \u003cp\u003e(8.38\u0026ndash;11.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.61\u003c/p\u003e \u003cp\u003e(8.16\u0026ndash;11.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e200\u0026ndash;399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.59\u003c/p\u003e \u003cp\u003e(5.71\u0026ndash;7.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.72\u003c/p\u003e \u003cp\u003e(5.42\u0026ndash;8.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.12\u003c/p\u003e \u003cp\u003e(5.75\u0026ndash;8.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.15\u003c/p\u003e \u003cp\u003e(5.31\u0026ndash;6.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.73\u003c/p\u003e \u003cp\u003e(7.35\u0026ndash;10.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.22\u003c/p\u003e \u003cp\u003e(6.29\u0026ndash;8.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.88\u003c/p\u003e \u003cp\u003e(7.68\u0026ndash;10.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.43\u003c/p\u003e \u003cp\u003e(4.78\u0026ndash;6.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.58\u003c/p\u003e \u003cp\u003e(4.57\u0026ndash;6.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.04\u003c/p\u003e \u003cp\u003e(5.17\u0026ndash;6.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.48\u003c/p\u003e \u003cp\u003e(4.61\u0026ndash;6.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003cp\u003e(5.34\u0026ndash;6.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.19\u003c/p\u003e \u003cp\u003e(6.27\u0026ndash;8.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.89\u003c/p\u003e \u003cp\u003e(6.17\u0026ndash;7.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e Prevalence estimates were weighted.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e values for trends were calculated using weighted logistic regression models, which included survey year as a continuous variable and adjusted for age, sex, race/ethnicity, education and family income to poverty ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a nationally representative population from the NSCH, we identified a weighted prevalence of ever-diagnosed LD at 8.80% and current-diagnosed LD at 8.20% among US children aged 6\u0026ndash;17 years in 2016\u0026ndash;2022. Ther was a significant increase in the prevalence of both ever and current LD over the past seven years. In the subgroups, we also found a significant increase in the average annual change in aged 12\u0026ndash;17 years, female, non-Hispanic white, a college or higher education, and family income of 200% FPL or above in the prevalence of both ever LD and current LD.\u003c/p\u003e \u003cp\u003eThe overall prevalence of LD in this study was slightly higher than those reported in other studies. A study analyzing the association between screen time and developmental disabilities among children aged 0\u0026ndash;17 years using NSCH data from 2018\u0026ndash;2020, noted a total LD prevalence of 7.2%.\u003csup\u003e22\u003c/sup\u003e Similarly, another research conducted by Zablotsky, which utilized NHIS data from 2009\u0026ndash;2017, estimated the prevalence at 7.74% among US children aged 3\u0026ndash;17 years.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Other research using NHIS data between 1997\u0026ndash;2021 found lower LD prevalence estimates, ranging from 7.62\u0026ndash;8.31%, compared to our current study.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Apart from the overall prevalence, we also found the prevalence differed significantly by age, sex, race/ethnicity, family education, and family income levels from 2016 to 2022, which was similar to other findings.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e State-based estimates ranged from 6.07% in Utah to 12.6% in New Hampshire.\u003c/p\u003e \u003cp\u003eLearning disabilities are difficult to diagnose, because the age at identification depends not only on the type and severity of the learning disabilities, but also on whether there are associated deficits.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Moreover, it is a lifelong condition and older children may have a higher prevalence rate and increasing trend due to longer exposure to the possibility of evaluation and diagnosis.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Nearly all studies have reported a higher prevalence of LD and other developmental disorders in boys than in girls.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Studies on gender discrepancies in LD have reported that females tend to have advantages in both verbal working memory and literacy, with better linguistic processing and reading fluency.\u003csup\u003e\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Additionally, our findings indicated that non-Hispanic blacks and non-Hispanic whites are more likely to be diagnosed with learning disabilities, with an increasing trend observed among non-Hispanic whites, which is consistent with findings observed in other studies \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Previous literature has suggested that limited access to healthcare services and language barriers could possibly account for the lower incidence of LD reported among Hispanic parents.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Consistent with other reports, LD is associated with family socioeconomic status. Lower household education and lower family income levels are linked with higher odds of LD.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Nicole et al. further suggested a connection between low socioeconomic status and diminished cognitive, academic, and behavioural performance in early childhood.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Particularly noteworthy was the observed increasing trend of LD in families with higher levels of education, such as college education or beyond. Although the reasons for this trend remain unclear, it's possible that the high expectations and demands from these parents lead to an over-reporting of LD.\u003c/p\u003e \u003cp\u003eOver the 7-year period from 2016 to 2022, our study revealed a significant annual average change in the prevalence of both ever-diagnosed and currently-diagnosed LD. The prevalence of ever-diagnosed LD increased from 7.86\u0026ndash;9.45%, and that of current-diagnosed LD from 7.32\u0026ndash;8.80%, indicating a 20% total increase in both types. However, such a significant rise was not observed in other studies pertaining to LD.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Over the past twenty-five years, the prevalence of LD, according to NHIS data, was recorded at 7.66% from 1997 to 2008,\u003csup\u003e36\u003c/sup\u003e 7.74% from 2009 to 2017,\u003csup\u003e23\u003c/sup\u003e and 7.6% from 2019 to 2020,\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e respectively. The discrepancy observed between learning disabilities estimates derived from NSCH data and those from NHIS data may partially stem from differences in data collection methods and the sample size between the two databases.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNon-etiological factors may be partly responsible for the increase in the prevalence of LD in this study. We estimated the prevalence of parent-reported LD using data from the NSCH; however, since the questionnaire only inquired about \u0026lsquo;\u0026lsquo;learning disabilities\u0026rsquo;\u0026rsquo; without specifying which disorders were regarded as LD, parents could have comprehended this term to describe an extensive range of learning difficulties.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The expansion of medical education and a growing emphasis on learning disabilities has led to an increased sensitivity of doctors towards diagnosing these conditions, as well as changes in the acceptance of the diagnosis of learning disabilities by parents and teachers, which have led to an increase in the prevalence of learning disabilities.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The availability of resources and the presence of other developmental disabilities can also significantly impact the number and prevalence of LD.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e As the prevalence of disorders such as Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) increases, so does the prevalence of LD due to the comorbidity of LD and ASD/ADHD.\u003csup\u003e40,42\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough the pathogenesis of learning disabilities is currently unclear, previous studies have suggested that genetic, neuropsychological, and environmental factors are contributory.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Certain heritable disorders even approach 100% penetrance, however, the clinical presentation can still be influenced by environmental risk factors.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e In terms of environmental triggers, prenatal and perinatal risk factors, including prematurity, low birthweight, maternal smoking, and maternal alcohol abuse during pregnancy, have been associated with LD risk.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e Stein et al. conducted an analysis of NHIS data involving 7817 children and discovered that those with moderately low birthweight were significantly more likely to be diagnosed with a learning disability compared to their normal birthweight counterparts.\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e Dietary behaviors have also been proposed to play a role in the increases in LD, exemplified by a study that found a high intake of sweetened desserts, fried food, and salt was associated with more learning disability.\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e Many proven or potential environmental biological factors are associated with learning disability, such as cadmium, phthalates, and lead.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e A study using data from NHANES showed that children in the highest quartile of urinary cadmium had significantly higher odds of LD when compared with those in the lowest quartile.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChildren with learning disabilities may experience social exclusion, bullying, poor self-image, and underachievement.\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e Research has confirmed that learning disabilities are lifelong;\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e this presents numerous challenges in various functional areas that adults with learning disabilities must adapt to, such as employment, family, social and emotional health, daily living routines, community life, and recreational and leisure activities.\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e Meanwhile, it is noteworthy that a family's level of education bears an impact on their economic status. Children living in poverty tend to score lower on standardized tests of academic achievement, a trend that continues into adulthood, subsequently leading to lower wages and incomes.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e In addition, the economic impact of increased LD prevalence on families, schools and the healthcare system is significant.\u003csup\u003e\u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e Forsyth et al. using data from the National Audit Commission and the Department of Health, reported widespread discrepancy from the median spend/ burden ratio standing at \u0026pound;10260 per person with learning disability.\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e According to a study conducted in Mumbai, the direct, indirect, and intangible costs associated with specific learning disability amounted to Indian Rupees (INR) 5936053, 29261220, and 42295000, respectively.\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e In the US, it's reported that over half of the students receiving special education services do so due to learning disabilities..\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Given the significant economic and social costs associated with LD, it is crucially important to continuously monitor the prevalence and characteristics of children diagnosed with these conditions.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe main advantage of this study is the use of a nationally representative sample of the US population, which allows us to generalize our findings to a wider population. Furthermore, by employing a series of nationwide, population-based, cross-sectional surveys, not only were we able to examine the secular trends in the prevalence of learning disabilities over a period of 7 years, but it also facilitated an assessment of the disparities in this prevalence relative to various population characteristics. This study has several limitations. First, the cross-sectional design of the NSCH does not permit the identification of how specific factors may influence the diagnosis of LD. Second, the reliance on parental reports for the diagnosis of LD could potentially invite inaccuracies due to misreporting and recall bias.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study presents a national and state-level overview of the epidemiology and characteristics of school-aged children with parent-reported diagnoses of LD from 2016 to 2022. We found a significant increase in the prevalence of both ever and current LD in US children over this period. Given the shifting trends in LD and the considerable impact it has on children, continual monitoring of its national prevalence is imperative.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDisclaimer\u003c/h2\u003e \u003cp\u003eThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Any errors or omissions are the responsibility of the authors.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr. W.Y. has full access to all of the data in this study and assumes responsibility for study supervision. Concept and design: W.Y., Y.Q., Acquisition, analysis, or interpretation of data: W.Y., C.X., Y.L., H.Y., Drafting of the manuscript: C.X., Y.L., Critical revision of the manuscript for important intellectual content: All authors, Statistical analysis: W.Y., C.X., Y.L., H.Y.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe data used in this study were obtained from the NSCH, a public database provided by the U.S. Centers for Disease Control and Prevention (CDC). The authors would like to acknowledge the support from all the team members and all staff of the CDC. This research was funded by the National Natural Science Foundation of China (Grant No. 81973063).\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe original contributions presented in the study are publicly available. The datasets analyzed during current study are available at NSCH online website: https://www.census.gov/programs-surveys/nsch.html.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHammill, D. D. On defining learning disabilities: an emerging consensus. J Learn Disabil 23, 74\u0026ndash;84 (1990).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyon, G. R. Learning disabilities. Future Child 6, 54\u0026ndash;76 (1996).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHandler, S. M. \u003cem\u003eet al.\u003c/em\u003e Learning disabilities, dyslexia, and vision. Pediatrics 127, e818-856 (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagae, L. Learning disabilities: definitions, epidemiology, diagnosis, and intervention strategies. Pediatr Clin North Am 55, 1259\u0026ndash;1268, vii (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillberg, C. \u0026amp; Soderstrom, H. 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J Postgrad Med 65, 152\u0026ndash;159 (2019).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Learning Disability, Epidemiology, Child, Adolescent, NSCH","lastPublishedDoi":"10.21203/rs.3.rs-4749516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4749516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe prevalence of learning disabilities (LD) among children is a critical public health issue; however, recent LD prevalence estimates among children and adolescents aged 6\u0026ndash;17 years, as reported by the National Survey of Children\u0026rsquo;s Health (NSCH), remain largely unexplored. Data for this population-based cross-sectional study were obtained from NSCH to estimate the prevalence of LD diagnosis among U.S. children at both national and state levels, and to inspect the 7-year trends in these estimates from 2016 to 2022. Among 187,805 U.S. children, 17,379 had a history of LD diagnosis, with a weighted prevalence of 8.80% (95% CI\u0026thinsp;=\u0026thinsp;8.52\u0026ndash;9.08). Of these, 16,221 were currently diagnosed with LD, yielding a weighted prevalence of 8.20% (95% CI\u0026thinsp;=\u0026thinsp;7.93\u0026ndash;8.48). From 2016 to 2022, the prevalence of ever-diagnosed LD increased from 7.86\u0026ndash;9.45%, and that of current-diagnosed LD from 7.32\u0026ndash;8.80%, indicating a 20% total increase in both types. The state with the highest prevalence (New Hampshire) had twice that of the state with the lowest prevalence (Utah). This study highlights a critical escalation in LD prevalence among US children and adolescents between 2016 and 2022. Comprehensive screening and support programs must be implemented to enhance early identification and intervention.\u003c/p\u003e","manuscriptTitle":"Rising Prevalence of Parent-Reported Learning Disabilities among U.S. Children and Adolescents Aged 6-17 years: NSCH, 2016-2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-16 16:12:57","doi":"10.21203/rs.3.rs-4749516/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d5e903a-198d-4d9f-af85-0bd9cf92c491","owner":[],"postedDate":"August 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35707943,"name":"Biological sciences/Neuroscience"},{"id":35707944,"name":"Health sciences/Diseases"},{"id":35707945,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-11-07T06:09:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-16 16:12:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4749516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4749516","identity":"rs-4749516","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}