Caballero Joshua, Xu Jianing, Hall Daniel B, Chen Xianyan, Young Henry N
PhD Student, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia.
Professor and Director, Statistical Consulting Center, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia.
Ment Health Clin. 2023 Aug 7;13(4):183-189. doi: 10.9740/mhc.2023.08.183. eCollection 2023 Aug.
In general, racial and ethnic differences exist in antipsychotic prescription practices. However, little is known about such differences between individual long-acting injectable (LAI) antipsychotic formulations, specifically. This study's primary objective was to determine racial and ethnic differences among LAI antipsychotic use. Secondary objectives were to identify if discontinuation rates differed between agents and by race or ethnicity.
International Classification of Diseases, 10th edition (ICD-10) codes were used to identify patients with schizophrenia and related disorders (18-64 years) who received an LAI antipsychotic between 2016 and 2020 using Merative Multi-State Medicaid databases. Using National Drug Code numbers for LAI antipsychotics, pharmacy claims were identified and data analyzed. Cochran-Mantel-Haenszel tests and odds ratio estimators were used to investigate conditional association between race or ethnicity and medication, while controlling for age, sex, health plan, and prescription year. Kaplan-Meier survival curves were examined, and stratified log-rank tests were conducted to compare the time until discontinuation distributions by race or ethnicity.
The analysis included 37 712 patients. Blacks received an LAI first-generation antipsychotic more often than Whites (OR: 1.64, 95% CI: [1.56, 1.73], Hispanics (OR: 1.46, 95% CI: [1.21, 1.75]) and others (OR: 1.44, 95% CI: [1.20, 1.73]). Aside from fluphenazine decanoate showing earlier discontinuation rates for Whites over Blacks ( = .02), no significant differences in discontinuation across race or ethnicity were identified.
Despite no significant differences in second-generation antipsychotic LAI discontinuation rates between Blacks and other racial or ethnic groups, Blacks received second-generation antipsychotic LAIs significantly less often than other groups. Further studies are needed to determine why differences may be occurring.
一般而言，抗精神病药物处方实践中存在种族和民族差异。然而，具体而言，关于长效注射（LAI）型抗精神病药物个体剂型之间的此类差异，人们知之甚少。本研究的主要目的是确定LAI抗精神病药物使用中的种族和民族差异。次要目的是确定不同药物以及不同种族或民族之间的停药率是否存在差异。
使用国际疾病分类第十版（ICD - 10）编码，通过默克多州医疗补助数据库识别2016年至2020年间接受LAI抗精神病药物治疗的精神分裂症及相关障碍患者（18 - 64岁）。利用LAI抗精神病药物的国家药品编码，识别药房报销记录并进行数据分析。采用 Cochr an - Mantel - Haenszel检验和比值比估计量来研究种族或民族与药物之间的条件关联，同时控制年龄、性别、健康保险计划和处方年份。检查Kaplan - Meier生存曲线，并进行分层对数秩检验，以比较不同种族或民族停药时间分布情况。
分析纳入了37712名患者。黑人比白人更常接受第一代LAI抗精神病药物（比值比：1.64，95%置信区间：[1.56, 1.73]），西班牙裔（比值比：1.46，95%置信区间：[1.21, 1.75]）和其他种族（比值比：1.44，95%置信区间：[1.20, 1.73]）。除氟奋乃静癸酸酯显示白人停药率早于黑人（P = 0.02）外，未发现不同种族或民族之间停药情况存在显著差异。
尽管黑人和其他种族或民族在第二代抗精神病药物LAI停药率方面没有显著差异，但黑人接受第二代抗精神病药物LAI的频率明显低于其他群体。需要进一步研究以确定差异产生的原因。
