Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
Department of Psychiatry, University of Oxford, Oxford, UK.
Soc Psychiatry Psychiatr Epidemiol. 2022 Jul;57(7):1341-1355. doi: 10.1007/s00127-022-02257-3. Epub 2022 Mar 4.
Clozapine is the most effective intervention for treatment-resistant schizophrenia (TRS). Several studies report ethnic disparities in clozapine treatment. However, few studies restrict analyses to TRS cohorts alone or address confounding by benign ethnic neutropenia. This study investigates ethnic equity in access to clozapine treatment for people with treatment-resistant schizophrenia spectrum disorder.
A retrospective cohort study, using information from 11 years of clinical records (2007-2017) from the South London and Maudsley NHS Trust. We identified a cohort of service-users with TRS using a validated algorithm. We investigated associations between ethnicity and clozapine treatment, adjusting for sociodemographic factors, psychiatric multi-morbidity, substance misuse, neutropenia, and service-use.
Among 2239 cases of TRS, Black service-users were less likely to be receive clozapine compared with White British service-users after adjusting for confounders (Black African aOR = 0.49, 95% CI [0.33, 0.74], p = 0.001; Black Caribbean aOR = 0.64, 95% CI [0.43, 0.93], p = 0.019; Black British aOR = 0.61, 95% CI [0.41, 0.91], p = 0.016). It was additionally observed that neutropenia was not related to treatment with clozapine. Also, a detention under the Mental Health Act was negatively associated clozapine receipt, suggesting people with TRS who were detained are less likely to be treated with clozapine.
Black service-users with TRS were less likely to receive clozapine than White British service-users. Considering the protective effect of treatment with clozapine, these inequities may place Black service-users at higher risk for hospital admissions and mortality.
氯氮平是治疗抵抗性精神分裂症（TRS）最有效的干预措施。有几项研究报告了氯氮平治疗中的种族差异。然而，很少有研究仅对 TRS 队列进行分析，或解决良性种族中性粒细胞减少症引起的混杂因素。本研究调查了治疗抵抗性精神分裂症谱系障碍患者接受氯氮平治疗的种族公平性。
这是一项使用南伦敦和莫兹利 NHS 信托 11 年（2007-2017 年）临床记录的回顾性队列研究。我们使用经过验证的算法确定了 TRS 患者队列。我们调查了种族与氯氮平治疗之间的关联，调整了社会人口因素、精神障碍多种共病、物质滥用、中性粒细胞减少症和服务使用情况。
在 2239 例 TRS 病例中，在调整混杂因素后，与白人英国服务使用者相比，黑人服务使用者接受氯氮平治疗的可能性较低（黑人非洲 aOR=0.49，95%CI[0.33，0.74]，p=0.001；黑人加勒比 aOR=0.64，95%CI[0.43，0.93]，p=0.019；黑人英国 aOR=0.61，95%CI[0.41，0.91]，p=0.016）。此外，还观察到中性粒细胞减少症与氯氮平治疗无关。此外，精神卫生法拘留与氯氮平接受率呈负相关，这表明接受 TRS 治疗的被拘留者不太可能接受氯氮平治疗。
与白人英国服务使用者相比，TRS 的黑人服务使用者接受氯氮平治疗的可能性较低。考虑到氯氮平治疗的保护作用，这些不平等可能使黑人服务使用者面临更高的住院和死亡风险。
