Racial Disparities in the Use of Second-Generation Antipsychotics for the Treatment of Schizophrenia

Mallinger, Julie B.; Fisher, Susan G.; Brown, Theodore J.; Lamberti, J. Steven

doi:10.1176/appi.ps.57.1.133

Cited by 52 publications

(33 citation statements)

References 11 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antipsychotic discontinuation is a significant predictor of relapse (Robinson et al 1999 Racial disparities in antipsychotic treatment have been reported in several studies (Bagchi et al 2004;dosReis et al 2002;Kilbourne and Pincus 2006;Kreyenbuhl et al 2003;Mallinger et al 2006). African-Americans are more likely to receive first generation antipsychotic medications relative to Whites or non-African-Americans (Bagchi et al 2004;Kilbourne and Pincus 2006;Mallinger et al 2006).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

dosReis

Johnson

Steinwachs

et al. 2008

Schizophrenia Research

View full text Add to dashboard Cite

Objective(s)-To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay.Method-Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1,727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia.Results-The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72 percent greater (95%CI: 30−75% greater, 49−100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20 percent longer than the average for continuous users (95%CI: 2−39% longer). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Lehman et al. 2004;Lehman et al. 1998). This results in fewer symptoms, a less episodic course (APA 1997), better clinical and functional outcomes for adults with schizophrenia (Lehman et al. 1995;Verdoux et al. 2000), and fewer relapses (Herz et al. 1991;Schooler 2006). Conclusions-Findings NIH Public AccessDespite this evidence, research on outpatient utilization spanning 1987−1997 shows that it rarely is continuous in a given year (dosReis et al. 2002;McCombs et al. 1999;Menzin et al. 2003;Mojtabai et al. 2002;Vanelli et al. 2001;Velligan et al. 2003;Williams et al. 1999).Only 12−30% of individuals received continuous antipsychotic treatment over a one year period (McCombs et al. 1999;Williams et al. 1999). From 17−24% of adults with schizophrenia do not receive medication in outpatient settings (dosReis et al. 2002;McCombs et al. 1999). Prescription refills over a nine-month period in 1998−1999 indicate that approximately 30% of individuals discontinue antipsychotic medication within three months after initiating treatment (Vanelli et al. 200...

show abstract

Section: Discussionmentioning

confidence: 99%

“…African-Americans are more likely to receive first generation antipsychotic medications relative to Whites or non-African-Americans (Bagchi et al 2004;Kilbourne and Pincus 2006;Mallinger et al 2006). Moreover, African-Americans have a shorter duration of treatment and receive higher daily doses compared to Whites (dosReis et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

dosReis

Johnson

Steinwachs

et al. 2008

Schizophrenia Research

View full text Add to dashboard Cite

show abstract

“…15,16 Differences in treatment according to race have been noted in adult diseases such as breast cancer, coronary heart disease, hypertension and schizophrenia. [17][18][19][20] We postulated that differences in delivery patterns for breech presentation may also exist by race, thereby contributing to racial disparities in neonatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Delivery mode by race for breech presentation in the US

2007

View full text Add to dashboard Cite

Objective: To determine if there are differential cesarean delivery rates by race and other socio-demographic factors for women with breech infants.Study Design: We calculated cesarean delivery rates for 186 727 White, African American, Hispanic and Asian women delivering breech singletons with gestational age 26 to 41 weeks born in 1999 and 2000 using data from the National Center for Health Statistics. Multivariable logistic regression was used to determine differences in mode of delivery by race, adjusting for socio-demographic and medical factors.Results: Cesarean rates for breech were >80% in most gestational age groups. In 14 of 18 groups, Whites had higher cesarean delivery rates than African Americans. However, this finding did not persist after risk adjustment. Hispanics were more likely to deliver by cesarean delivery than African Americans and Whites.Conclusion: Breech singleton infants are predominantly born by cesarean delivery. Although African-American women with breech presentation have lower cesarean delivery rates than Whites, this difference is not present after adjusting for socio-demographic and medical factors. Hispanics were more likely to be delivered by cesarean delivery and this difference was amplified after risk adjustment. Asians had slightly lower cesarean rates after risk adjustment, but this varied widely according to Asian subgroup.

show abstract

“…A more recent study (Mallinger 2006) suggested that African American patients were six times less likely to receive an SGA and half as likely to receive clozapine as White people after controlling for clinical and sociodemographic factors. Possible reasons for this are prescribers' beliefs that African American patients may not adhere to clozapine treatment or to its blood monitoring requirement, or that clinicians are apprehensive about the efficacy of clozapine in Black and minority ethnic groups, which are poorly represented in clinical trials and report a higher prevalence of metabolic complications (Kelly 2006).…”

Section: Variability Of Clozapine Prescribing Among Different Ethnic mentioning

confidence: 99%

Underuse of clozapine in treatment-resistant schizophrenia

Mistry¹,

Osborn²

2011

Adv. psychiatr. treat

View full text Add to dashboard Cite

SummaryUp to a third of patients with schizophrenia develop treatment resistance. Clozapine has been established as the most effective antipsychotic medication for treatment-resistant schizophrenia. However, it is significantly underutilised in this population. Possible reasons include clinicians' lack of experience with the drug and negative attitudes towards it. African-Caribbean patients are less likely to be treated with clozapine compared with their White counterparts and more likely to have treatment discontinued due to perceived risk of agranulocytosis. This paper discusses the current evidence relating to the underuse of clozapine and factors responsible for this.

show abstract

Racial Disparities in the Use of Second-Generation Antipsychotics for the Treatment of Schizophrenia

Abstract: In this sample, blacks were less likely than whites to receive second-generation antipsychotics, demonstrating a persistent gap in the quality of care for patients with schizophrenia.

Cited by 52 publications

References 11 publications

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

Delivery mode by race for breech presentation in the US

Underuse of clozapine in treatment-resistant schizophrenia

Contact Info

Product

Resources

About