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Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 12, pp 1861–1872 | Cite as

Racial and ethnic disparities in the use of antipsychotic medication: a systematic review and meta-analysis

  • Joseph H. Puyat
  • Jamie R. Daw
  • Colleen M. Cunningham
  • Michael R. Law
  • Sabrina T. Wong
  • Devon L. Greyson
  • Steven G. Morgan
Original Paper

Abstract

Objective

To conduct a systematic review and meta-analysis of published evidence on ethnic or racial disparities in the outpatient use versus non-use of antipsychotics and in the outpatient use of newer versus older antipsychotics.

Method

Electronic databases were searched for potentially relevant studies. Two independent reviewers conducted the review in three stages: title review, abstract review and full-text review. Included studies were those that: (a) report measures of disparity in the outpatient use of antipsychotic drugs in clearly defined racial or ethnic groups (b) have a primary focus on ethnic or racial disparities, and (c) have adjusted for factors known to influence medicine use. Odds ratios were pooled following the inverse-variance method of weighting effect sizes. I 2 statistics were calculated to quantify the amount of variation that is likely due to heterogeneity between studies. Funnel plots were produced and Egger’s statistic was calculated to assess potential publication bias.

Results

No significant differences were found in the odds of using any antipsychotics among African Americans (OR = 1.01, CI = 0.99–1.02) compared with non-African Americans and among Latinos (OR = 0.98, CI = 0.86–1.13) compared with non-Latinos. Small to moderate but statistically non-significant disparities were also noted in other ethnic groups: Asians (OR = 1.10, CI = 0.88–1.36), Maoris (OR = 0.78, CI = 0.53–1.13) and Pacific Islanders (OR = 0.97, CI = 0.84–1.11). Among those who received antipsychotic medication, African Americans (OR = 0.62, CI = 0.50–0.78) and Latinos (OR = 0.77, CI = 0.73–0.81) appeared to have lower odds of receiving newer antipsychotics compared with non-African Americans and non-Latinos.

Conclusion

No significant ethnic disparities in the use versus non-use of any antipsychotics were observed, but, among those who received antipsychotic treatment, ethnic minorities were consistently less likely than non-ethnic minorities to be treated with newer antipsychotics.

Keywords

Racial Ethnic Disparities Antipsychotics Schizophrenia 

Notes

Conflict of interest

The authors report no competing interests.

References

  1. 1.
    Association AP (2000) Diagnostic and statistical manual of mental disorders DSM-IV-TR, 4th edn. American Psychiatric Publication, WashingtonGoogle Scholar
  2. 2.
    Bhugra D (2005) The global prevalence of schizophrenia. PLoS Med. 2(5):e151PubMedCrossRefGoogle Scholar
  3. 3.
    Knapp M, Mangalore R, Simon J (2004) The Global Costs of Schizophrenia. Schizophr Bull 30(2):279–293PubMedCrossRefGoogle Scholar
  4. 4.
    Gaebel W, Weinmann S, Sartorius N, Rutz W, McIntyre JS (2005) Schizophrenia practice guidelines: international survey and comparison. Br J Psychiatry 187(3):248–255PubMedCrossRefGoogle Scholar
  5. 5.
    Meltzer HY (2004) What’s atypical about atypical antipsychotic drugs? Curr Opin Pharmacol 4(1):53–57PubMedCrossRefGoogle Scholar
  6. 6.
    Baillargeon J, Contreras SA (2001) Antipsychotic prescribing patterns in the Texas prison system. J Am Acad Psychiatry Law 29(1):48–53PubMedGoogle Scholar
  7. 7.
    Copeland LA, Zeber JE, Valenstein M, Blow FC (2003) Racial disparity in the use of atypical antipsychotic medications among veterans. Am J Psychiatry 160(10):1817–1822PubMedCrossRefGoogle Scholar
  8. 8.
    Kreyenbuhl J, Zito JM, Buchanan RW, Soeken KL, Lehman AF (2003) Racial disparity in the pharmacological management of schizophrenia. Schizophr Bull 29(2):183–193PubMedCrossRefGoogle Scholar
  9. 9.
    Covell NH, Jackson CT, Evans AC, Essock SM (2002) Antipsychotic prescribing practices in Connecticut’s public mental health system: rates of changing medications and prescribing styles. Schizophr Bull 28(1):17–29PubMedCrossRefGoogle Scholar
  10. 10.
    Smedley BD, Stith AY, Nelson AR (2003) Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, WashingtonGoogle Scholar
  11. 11.
    Andersen R, Newman JF (2005) Societal and individual determinants of medical care utilization in the United States. Milbank Q 83(4):1–24Google Scholar
  12. 12.
    Woolf B (1955) On estimating the relation between blood group and disease. Ann Hum Genet 19(4):251–253PubMedCrossRefGoogle Scholar
  13. 13.
    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedCrossRefGoogle Scholar
  14. 14.
    Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996PubMedCrossRefGoogle Scholar
  15. 15.
    StataCorp (2007) Stata statistical software: Release 10. StataCorp LP, College StationGoogle Scholar
  16. 16.
    Bagchi A, Sambamoorthi U, McSpiritt E, Yanos P, Walkup J, Crystal S (2004) Use of antipsychotic medications among HIV-infected individuals with schizophrenia. Schizophr Res 71(2–3):435–444PubMedCrossRefGoogle Scholar
  17. 17.
    Busch AB, Lehman AF, Goldman H, Frank RG (2009) Changes over time and disparities in schizophrenia treatment quality. Med Care 47(2):199–207PubMedCrossRefGoogle Scholar
  18. 18.
    Jano E, Johnson M, Chen H, Aparasu RR (2008) Determinants of atypical antipsychotic use among antipsychotic users in community-dwelling elderly, 1996–2004. Curr Med Res Opin 24(3):709–716PubMedCrossRefGoogle Scholar
  19. 19.
    Sleath BL, Jackson E, Thomas KC, Galloway J, Dumain L, Thorpe J et al (2006) Racial differences in the use of antidepressants and counseling for depression among homeless women. Community Ment Health J 42(1):77–85PubMedCrossRefGoogle Scholar
  20. 20.
    Sohler NL, Bromet EJ, Lavelle J, Craig TJ, Mojtabai R (2004) Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization? Psychol Med 34(4):705–718PubMedCrossRefGoogle Scholar
  21. 21.
    Woods SW, Sullivan MC, Neuse EC, Diaz E, Baker CB, Madonick SH et al (2003) Best practices: racial and ethnic effects on antipsychotic prescribing practices in a Community Mental Health Center. Psychiatr Serv 54(2):177PubMedCrossRefGoogle Scholar
  22. 22.
    Wheeler A, Humberstone V, Robinson E (2008) Ethnic comparisons of antipsychotic use in schizophrenia. Aust NZ J Psychiatry 42(10):863–873CrossRefGoogle Scholar
  23. 23.
    Pinto R, Ashworth M, Seed P, Rowlands G, Schofield P, Jones R (2010) Differences in the primary care management of patients with psychosis from two ethnic groups: a population-based cross-sectional study. Fam Pract 27(4):439–446PubMedCrossRefGoogle Scholar
  24. 24.
    Sleath B, Domino ME, Wiley-Exley E, Martin B, Richards S, Carey T (2010) Antidepressant and antipsychotic use and adherence among Medicaid youths: differences by race. Community Ment Health J 46(3):265–272PubMedCrossRefGoogle Scholar
  25. 25.
    Cooper C, Spiers N, Livingston G, Jenkins R, Meltzer H, Brugha T et al (2012) Ethnic inequalities in the use of health services for common mental disorders in England. Soc Psychiatry Psychiatr Epidemiol 48(5):685–692PubMedCrossRefGoogle Scholar
  26. 26.
    Stein BD, Sorbero MJ, Dalton E, Ayers AM, Farmer C, Kogan JN et al (2012) Predictors of adequate depression treatment among Medicaid-enrolled youth. Soc Psychiatry Psychiatr Epidemiol 48(5):757–765PubMedCrossRefGoogle Scholar
  27. 27.
    Ivert A-K, Merlo J, Svensson R, Levander MT (2012) How are immigrant background and gender associated with the utilisation of psychiatric care among adolescents? Soc Psychiatry Psychiatr Epidemiol 48(5):693–699PubMedCrossRefGoogle Scholar
  28. 28.
    Canadian Psychiatric Association (2005) Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry 50(13 Suppl 1):7S–57SGoogle Scholar
  29. 29.
    American Psychiatric Association (2004) APA practice guidelines for the treatment of psychiatric disorders: comprehensive guidelines and guideline watches [Internet], 2nd edn. American Psychiatric Association, Arlington; [cited 2010 Mar 30]. http://www.psychiatryonline.com/pracGuide/pracguideChapToc_6.aspx
  30. 30.
    Hargraves JL (2004) Trends in health insurance coverage and access among black, Latino and white Americans, 2001–2003. Center for Studying Health System Change, WashingtonGoogle Scholar
  31. 31.
    Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB (2005) State of disparities in cardiovascular health in the United States. Circulation 111(10):1233–1241PubMedCrossRefGoogle Scholar
  32. 32.
    Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP, Hazuda HP (2003) All-cause and cardiovascular mortality among Mexican-American and non-Hispanic White older participants in the San Antonio Heart Study-evidence against the “Hispanic paradox”. Am J Epidemiol 158(11):1048–1057PubMedCrossRefGoogle Scholar
  33. 33.
    Henderson DC (2005) Metabolic differences of antipsychotics among the races. CNS Spectr 10(3 Suppl 2):13–20Google Scholar
  34. 34.
    Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2006) Comparison of two methods to detect publication bias in meta-analysis. JAMA 295(6):676–680PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Joseph H. Puyat
    • 1
  • Jamie R. Daw
    • 1
  • Colleen M. Cunningham
    • 1
  • Michael R. Law
    • 1
  • Sabrina T. Wong
    • 1
  • Devon L. Greyson
    • 1
  • Steven G. Morgan
    • 1
  1. 1.Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada

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