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Disparities in antipsychotic medication use

Vancouver, BC, Canada: University of British Columbia (masters thesis).

University of British Columbia, Vancouver, BC, Canada

OBJECTIVES: To examine ethnic and income-related disparities in the use of antipsychotic medication by conducting a systematic review of the related literature and a secondary data analysis.

METHODS: The review was conducted using a protocol developed to systematically search, select and review peer-reviewed articles on ethnic disparities in antipsychotic use. Study selection and data abstraction were performed by two independent reviewers. The secondary data analysis was conducted to examine income-related disparities in antipsychotic use in three cohorts. The first cohort was comprised of 19 to 64-year olds who had a recorded schizophrenia diagnosis. Income-related differences in the essential use of antipsychotics were assessed in this cohort. The second cohort was comprised of seniors (65 years and older) who had a recorded dementia but not schizophrenia or bipolar disorder diagnosis. The third cohort was of children and youth (18 years and younger) who had no recorded schizophrenia or bipolar disorder diagnosis. Income-related differences in the potentially inappropriate use of antipsychotics were studied in these last two cohorts. Disparities in antipsychotic use were assessed using logistic regression, adjusting for factors that influence medicine use (i.e., age, sex, health status, relevant diagnoses and residence in urban areas).

RESULTS: The systematic review found no consistent evidence of ethnic disparities in the receipt of antipsychotic treatment. However, among those who were treated, ethnic minorities were found to be consistently less likely than non minorities to receive the newer type of antipsychotics. Results of the secondary data analyses indicate that the odds of essential antipsychotic use were lower in low-income individuals than those with higher incomes. Odds of exposure to potentially inappropriate antipsychotic use, on the other hand, were higher among low-income individuals and seniors in long-term care.

CONCLUSION: There is evidence of persistent disparities in the use of antipsychotic medication. Periodic examination and studies that identify causal factors and effective interventions are needed to reduce disparities.