Jones Mary Elizabeth, Petersen Irene, Walters Kate, Bhanu Cini, Manthorpe Jill, Raine Rosalind, Mukadam Naaheed, Cooper Claudia
Department of Primary Care and Population Health, University College London, London, UK.
NIHR Health and Social Care Workforce Research Unit, King's College London, London, UK.
Clin Epidemiol. 2020 Jan 20;12:61-71. doi: 10.2147/CLEP.S222126. eCollection 2020.
To test hypotheses that minority ethnic people with dementia in the UK receive fewer anti-dementia drugs and more psychotropic and anticholinergic drugs associated with harms.
We analyzed UK primary care electronic health records from The Health Improvement Network (THIN) database (2014-2016), comparing psychotropic drug prescribing initiation and duration between people with dementia from White, Black, and Asian ethnic groups. We repeated analyses in people (aged 50+) without dementia, to explore whether any differences found reflected prescribing patterns in the general older population, or were specific to dementia.
We included 53,718 people with and 1,648,889 people without dementia. Among people with dementia, compared to White ethnic groups, Asian people were less likely to be prescribed anti-dementia drugs when they were potentially indicated (adjusted prevalence rate ratio 0.86 (95% Confidence Interval 0.76-0.98)), and received them for on average 15 days/year less. Compared to White groups, Asian and Black individuals with dementia were no more likely to take an antipsychotic drug, but those that had were prescribed them for 17 and 27 days/year more, respectively (190.8 (179.6-199.1) and 200.7 (191.1-206.5) days). Black people were less likely to be prescribed anxiolytics/hypnotics (0.60 (0.44-0.8)), but the duration these drugs were prescribed was similar across ethnic groups. Asian people were more likely to be prescribed anticholinergic drugs (1.43 (1.19-1.73)), in analyses unadjusted for cardiovascular comorbidities. Among people without dementia, those in the Asian and Black ethnic groups were less likely to be prescribed psychotropic drugs, relative to people from White groups.
Among people with dementia, Asian groups received less potentially beneficial symptomatic treatments, and Asian and Black groups were prescribed antipsychotic drugs for longer than White ethnic groups. Our findings may indicate care inequalities.
检验以下假设，即英国患有痴呆症的少数族裔人群服用抗痴呆药物的剂量较少，而服用与危害相关的精神药物和抗胆碱能药物的剂量较多。
我们分析了来自健康改善网络（THIN）数据库（2014 - 2016年）的英国初级医疗电子健康记录，比较了白人、黑人和亚裔族裔痴呆症患者精神药物处方的起始情况和持续时间。我们对无痴呆症的人群（50岁以上）重复进行了分析，以探究所发现的任何差异是反映了老年人群总体的处方模式，还是痴呆症患者特有的情况。
我们纳入了53718名患有痴呆症的患者和1648889名无痴呆症的患者。在患有痴呆症的患者中，与白人种族群体相比，亚裔人群在有潜在用药指征时，被开具抗痴呆药物的可能性较小（调整后的患病率比值为0.86（95%置信区间0.76 - 0.98）），且每年服用抗痴呆药物的天数平均少15天。与白人种族群体相比，患有痴呆症的亚裔和黑人服用抗精神病药物的可能性并不更高，但服用抗精神病药物的天数分别比白人多17天和27天（190.8（179.6 - 199.1）天和200.7（191.1 - 206.5）天）。黑人被开具抗焦虑药/催眠药的可能性较小（0.60（0.44 - 0.8）），但这些药物的处方持续时间在各民族群体中相似。在未对心血管合并症进行调整的分析中，亚裔人群被开具抗胆碱能药物的可能性更大（1.43（1.19 - 1.73））。在无痴呆症的人群中，与白人种族群体相比，亚裔和黑人种族群体被开具精神药物的可能性较小。
在患有痴呆症的人群中，亚裔群体接受的潜在有益的对症治疗较少，并且亚裔和黑人群体服用抗精神病药物的时间比白人种族群体更长。我们的研究结果可能表明存在医疗不平等现象。
