Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA.
College of Pharmacy and Health Sciences, Purdue University, West Lafayette, Indiana, USA; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Center for Healthcare Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA.
Sleep Health. 2023 Apr;9(2):128-135. doi: 10.1016/j.sleh.2023.02.002. Epub 2023 Feb 27.
Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort.
Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis.
In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications.
Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.
在一个大型多机构队列中，研究种族与失眠药物治疗时间之间的关系。
对区域健康信息交换的电子病历进行回顾性分析。合格的患者包括 2010 年至 2019 年期间每年至少有一次就诊记录、研究期间有新的失眠诊断代码且无先前失眠诊断代码或药物治疗的成年人。使用 Cox 脆弱性模型来检查种族与诊断后失眠药物治疗时间之间的关系。
共分析了 9557 例患者，其中 7773 例（81.3%）为白人，1294 例（13.5%）为黑人，238 例（2.5%）为其他种族，252 例（2.6%）为未知种族。与白人患者相比，约 6.2%的黑人患者和 8%的其他种族患者在诊断后接受了美国食品和药物管理局批准的失眠药物治疗。在所有时间点，黑人患者接受美国食品和药物管理局批准的失眠药物治疗的可能性均显著降低（调整后的危险比[aHR]范围：0.37-0.73），报告其他种族的患者在 2 年（aHR 0.51，95%置信区间[CI]0.28-0.94）、3 年（aHR 0.33，95%CI 0.13-0.79）和 4 年（aHR 0.21，95%CI 0.06-0.71）的随访中接受治疗的可能性也较低。在包括非标签药物的敏感性分析中观察到了类似的结果。
在考虑了社会人口统计学和临床因素后，属于少数族裔的患者比白人患者更有可能被开处失眠药物。需要进一步研究以确定患者偏好和医生认知在多大程度上影响这些处方模式，并调查非药物治疗方面的潜在差异。
