TOPLINE:
Black patients with schizophrenia are less likely to receive a clozapine prescription compared with White patients, a new study shows. The findings held even after the researchers controlled for demographic variables, social determinants of health, and care access patterns.
METHODOLOGY:
- The study drew on structured electronic health record data on 3160 adult patients with schizophrenia.
- The mean age at first recorded diagnosis was 39.5 years; 70% of participants were male, 53% Black, and 91% resided in an urban setting.
- The researchers used the social vulnerability index (SVI) to quantify social determinants of health.
- Descriptive data analysis, logistic regression, and sensitivity analysis were used to identify differences between those who received a clozapine prescription and those who were prescribed antipsychotic medications other than clozapine.
TAKEAWAY:
- Overall, 401 patients received a clozapine prescription, 51% of whom were White and 40% were Black.
- Moreover, 19% of all White patients in the study received clozapine vs 10% of Black patients.
- After the researchers controlled for demographic variables, SVI scores, and care patterns, White patients were significantly more likely to receive a clozapine prescription than Black patients (adjusted odds ratio [aOR], 1.71; P < .001).
- Factors that had a statistically significant influence on the likelihood of receiving a clozapine prescription were minority status and language (OR, 2.97; P < .007), treatment duration (OR, 1.36; P < .001), and socioeconomic status (OR, 0.27; P = .001).
IN PRACTICE:
“The reasons for the underprescription of clozapine among Black patients with schizophrenia are multifactorial and may include concerns about benign ethnic neutropenia, prescriber bias, prescribers’ anticipation of patients’ nonadherence to the treatment, and the notion that the medication is less effective for Black patients,” the authors wrote.
SOURCE:
Xiaoming Zeng, MD, PhD, professor of psychiatry, University of North Carolina, Chapel Hill, North Carolina, was the senior and corresponding on the study. It was published online on March 19 in Psychiatric Services.
LIMITATIONS:
Due to the study’s cross-sectional and single-site design, the findings may not be generalizable to other geographic areas or institutions. The study lacked information on substance use disorders, common health conditions, or other patient-level data. A question remains whether all patients who received clozapine actually had treatment-resistant schizophrenia because other research has shown that there is an overdiagnosis of schizophrenia among Black patients.
DISCLOSURES:
The study was supported by a grant from the Foundation of Hope. Dr. Zeng reported no relevant financial relationships. The other authors’ disclosures are listed on the original paper.
A version of this article appeared on Medscape.com.