Khorassani Farah, Entsuah-Boateng Nana, Sayer Michael, Ozaki Aya
Department of Clinical Pharmacy Practice, Irvine School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, California.
Corresponding Author: Farah Khorassani, PharmD, BCPP, University of California, Irvine School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy Practice, 807 W Peltason Dr, Irvine, CA 92617 (
J Clin Psychiatry. 2025 Feb 3;86(1):24m15524. doi: 10.4088/JCP.24m15524.
To investigate racial disparities in the first-time prescription of mood stabilizers for first-episode mania in nonpsychotic, hospitalized patients with bipolar I disorder, specifically comparing the rates of lithium and valproic acid prescription between non-Hispanic Black and non-Hispanic White patients. A retrospective cohort study was conducted using the TriNetX database. We included eligible hospitalized non Hispanic Black and non-Hispanic White patients newly diagnosed with bipolar I disorder without psychotic features between January 1, 2014, and December 31, 2023. Propensity score matching was employed to create balanced comparison populations of non-Hispanic Black and non-Hispanic White patients, controlling for factors that may influence medication selection. A measure of association analysis was performed to calculate and compare the fraction of patients with either lithium or valproic acid use in both cohorts. Odds ratios were assessed. The study included 1,582 patients (N = 791 per cohort). After propensity matching, baseline characteristics were well balanced. Lithium was prescribed to 24% of White patients compared to 15% of Black patients (odds ratio [OR] 1.82, 95% CI, 1.41-2.35, < .05). Conversely, valproic acid was prescribed to 20% of Black patients compared to 12% of White patients (OR 0.53 95% CI, 0.40-0.71, < .05). Significant disparities in the prescription rates of valproic acid and lithium were observed, with Black patients more likely to receive valproic acid and less likely to receive lithium compared to their White counterparts. Efforts to address these inequities should involve addressing structural, patient-related, and clinician-related factors that may contribute to our findings.
为了调查非精神病性双相I型障碍住院患者首次发作躁狂时心境稳定剂首次处方中的种族差异，具体比较非西班牙裔黑人和非西班牙裔白人患者中锂盐和丙戊酸的处方率。使用TriNetX数据库进行了一项回顾性队列研究。我们纳入了2014年1月1日至2023年12月31日期间新诊断为无精神病特征的双相I型障碍的符合条件的住院非西班牙裔黑人和非西班牙裔白人患者。采用倾向评分匹配法创建非西班牙裔黑人和非西班牙裔白人患者的均衡比较人群，控制可能影响药物选择的因素。进行关联分析以计算和比较两个队列中使用锂盐或丙戊酸的患者比例。评估优势比。该研究包括1582名患者（每个队列N = 791）。倾向匹配后，基线特征得到了很好的平衡。24%的白人患者开具了锂盐处方，而黑人患者为15%（优势比[OR] 1.82，95%置信区间，1.41 - 2.35，P <.05）。相反，20%的黑人患者开具了丙戊酸处方，而白人患者为12%（OR 0.53，95%置信区间，0.40 - 0.71，P <.05）。观察到丙戊酸和锂盐的处方率存在显著差异，与白人患者相比，黑人患者更有可能接受丙戊酸，而接受锂盐的可能性更小。解决这些不平等问题的努力应涉及解决可能导致我们研究结果的结构、患者相关和临床医生相关因素。
