Busch Alisa B, Huskamp Haiden A, Neelon Brian, Manning Tim, Normand Sharon-Lise T, McGuire Thomas G
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts 02478, USA.
Med Care. 2009 Dec;47(12):1217-28. doi: 10.1097/MLR.0b013e3181adcc4f.
To examine racial/ethnic longitudinal disparities in antimanic medication use among adults with bipolar-I disorder.
Observational study using administrative data from Florida's Medicaid program, July 1997 to June 2005, for enrollees diagnosed with bipolar-I disorder (N = 13,497 persons; 126,413 person-quarters). We examined the likelihood of receiving one of the following during a given quarter: (1) any antimanic agent (antipsychotic or mood stabilizer) or none, and (2) mood stabilizers, antipsychotic monotherapy, or neither. Binary and multinomial logistic regression models predicted the association between race/ethnicity and prescription fills, adjusting for clinical and demographic characteristics. Cohort indicators for year that the enrollee met study criteria were included to account for cohort effects.
Averaging over all cohorts and quarters, compared with whites, blacks had lower odds of filling any antimanic and mood stabilizer prescriptions specifically (40%-49% and 47%-63%, respectively), but similar odds of filling prescriptions for antipsychotic monotherapy. After Bonferroni adjustment, compared with whites, there were no statistically significant disparities for Hispanics in filling prescriptions for any, or specific antimanic medications.
Rates of antimanic medication use were low regardless of race/ethnicity. However, we found disparities in antimanic medication use for blacks compared with whites and these disparities persisted over time. We found no Hispanic-white disparities. Quality improvement efforts should focus on all individuals with bipolar disorder, but particular attention should be paid to understanding disparities in medication use for blacks.
研究患有双相I型障碍的成年人在使用抗躁狂药物方面的种族/族裔纵向差异。
采用观察性研究，使用佛罗里达州医疗补助计划1997年7月至2005年6月的管理数据，研究对象为被诊断患有双相I型障碍的参保者（N = 13497人；126413人季度）。我们考察了在给定季度内接受以下情况之一的可能性：（1）任何抗躁狂药物（抗精神病药或心境稳定剂）或不接受任何药物，以及（2）心境稳定剂、抗精神病药单一疗法或两者都不接受。二元和多项逻辑回归模型预测种族/族裔与处方配药之间的关联，并对临床和人口统计学特征进行调整。纳入参保者符合研究标准年份的队列指标以考虑队列效应。
在所有队列和季度中进行平均计算，与白人相比，黑人开具任何抗躁狂药物和特定心境稳定剂处方的几率较低（分别为40%-49%和47%-63%），但开具抗精神病药单一疗法处方的几率相似。经过邦费罗尼校正后，与白人相比，西班牙裔在开具任何抗躁狂药物或特定抗躁狂药物处方方面没有统计学上的显著差异。
无论种族/族裔如何，抗躁狂药物的使用率都较低。然而，我们发现黑人与白人在抗躁狂药物使用方面存在差异，且这些差异随时间持续存在。我们未发现西班牙裔与白人之间存在差异。质量改进工作应关注所有双相情感障碍患者，但应特别关注了解黑人在药物使用方面的差异。
