Dr. Lim is with the Department of Public Health, Des Moines University, Des Moines, Iowa. Dr. Jung is with the Department of Health Policy and Administration, Pennsylvania State University, University Park.
Psychiatr Serv. 2017 Dec 1;68(12):1271-1279. doi: 10.1176/appi.ps.201600445. Epub 2017 Aug 15.
The objective of this study was to examine whether and to what extent racial-ethnic differences exist in off-label use of antidepressant drugs by insurance type (Medicare, Medicaid, private coverage, and uninsured).
Multiyear data (2000-2010) from Medical Expenditure Panel Surveys were used. Logistic and negative binomial regressions were used for the likelihood and frequency analyses, respectively.
The likelihood of filling prescriptions for off-label use of antidepressants was greater among blacks than among whites in all insurance groups (Medicare [N=6,470], adjusted odds ratio [AOR]=1.68; Medicaid [N=3,076], AOR=1.76; private coverage [N=9,918], AOR=2.10; and uninsured [N=1,826], AOR=1.88). Only in the uninsured group were Hispanics more likely than whites to use antidepressants off label (AOR=1.58). Among off-label antidepressant users, blacks and Hispanics with private coverage filled significantly fewer off-label antidepressant prescriptions than whites (blacks, incidence rate ratio [IRR]=.81; Hispanics, IRR=.88).
Off-label use of antidepressants was more likely among blacks than among whites in all insurance groups; however, once whites initiated off-label use of antidepressants, they tended to fill off-label antidepressant prescriptions more frequently than blacks or Hispanics. Because off-label use may be inappropriate, clinical and policy efforts should aim to reduce off-label antidepressant use, with particular attention to racial-ethnic differences.
本研究旨在考察保险类型（医疗保险、医疗补助、私人保险和无保险）是否存在以及在何种程度上存在抗抑郁药的标签外使用的种族差异。
使用多年度（2000-2010 年）医疗支出面板调查数据。逻辑回归和负二项回归分别用于可能性和频率分析。
在所有保险组（医疗保险[N=6470]，调整后的优势比[OR]=1.68；医疗补助[N=3076]，OR=1.76；私人保险[N=9918]，OR=2.10；无保险[N=1826]，OR=1.88）中，黑人开抗抑郁药标签外处方的可能性大于白人。只有在无保险组中，西班牙裔比白人更有可能开抗抑郁药标签外处方（OR=1.58）。在使用标签外抗抑郁药的患者中，拥有私人保险的黑人和西班牙裔人开的标签外抗抑郁药处方明显少于白人（黑人，发病率比[IRR]=0.81；西班牙裔，IRR=0.88）。
在所有保险组中，黑人使用抗抑郁药标签外的可能性均大于白人；然而，一旦白人开始使用抗抑郁药标签外用药，他们往往比黑人或西班牙裔人更频繁地开标签外抗抑郁药处方。由于标签外使用可能不合适，临床和政策努力应旨在减少标签外抗抑郁药的使用，特别关注种族差异。
