Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data
Introduction 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...
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| Format: | Article |
| Language: | English |
| Published: |
American Association of Psychiatric Pharmacists
2023-08-01
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| Series: | Mental Health Clinician |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2023.08.183 |
| _version_ | 1797383337238593536 |
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| author | Caballero Joshua PharmD, BCPP, FCCP Xu Jianing MS Hall Daniel B. PhD Chen Xianyan PhD Young Henry N. PhD |
| author_facet | Caballero Joshua PharmD, BCPP, FCCP Xu Jianing MS Hall Daniel B. PhD Chen Xianyan PhD Young Henry N. PhD |
| author_sort | Caballero Joshua PharmD, BCPP, FCCP |
| collection | DOAJ |
| description | Introduction
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.
Methods
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.
Results
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 (P = .02), no significant differences in discontinuation across race or ethnicity were identified.
Discussion
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. |
| first_indexed | 2024-03-08T21:18:34Z |
| format | Article |
| id | doaj.art-95953c0eadaf4dbdbec567925927df5f |
| institution | Directory Open Access Journal |
| issn | 2168-9709 |
| language | English |
| last_indexed | 2024-03-08T21:18:34Z |
| publishDate | 2023-08-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj.art-95953c0eadaf4dbdbec567925927df5f2023-12-21T12:17:22ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092023-08-0113418318910.9740/mhc.2023.08.183i2168-9709-13-4-183Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims dataCaballero Joshua PharmD, BCPP, FCCP0Xu Jianing MS1Hall Daniel B. PhD2Chen Xianyan PhD3Young Henry N. PhD41 Associate Professor – Limited Term, Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia2 PhD Student, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia3 Professor and Director, Statistical Consulting Center, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia4 Senior Academic Professional, Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia5 Department Head and Kroger Professor, Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GeorgiaIntroduction 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. Methods 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. Results 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 (P = .02), no significant differences in discontinuation across race or ethnicity were identified. Discussion 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.https://theijpt.org/doi/pdf/10.9740/mhc.2023.08.183long-acting injectable antipsychoticsschizophreniadiscontinuationadherenceraceethnicity |
| spellingShingle | Caballero Joshua PharmD, BCPP, FCCP Xu Jianing MS Hall Daniel B. PhD Chen Xianyan PhD Young Henry N. PhD Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data Mental Health Clinician long-acting injectable antipsychotics schizophrenia discontinuation adherence race ethnicity |
| title | Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data |
| title_full | Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data |
| title_fullStr | Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data |
| title_full_unstemmed | Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data |
| title_short | Racial and ethnic differences in patterns of use and discontinuation of long-acting injectable antipsychotics using Medicaid claims data |
| title_sort | racial and ethnic differences in patterns of use and discontinuation of long acting injectable antipsychotics using medicaid claims data |
| topic | long-acting injectable antipsychotics schizophrenia discontinuation adherence race ethnicity |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2023.08.183 |
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