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

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.

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Conflict of interest

The authors report no competing interests.

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Corresponding author

Correspondence to Joseph H. Puyat.

Appendix

Appendix

Systematic review search strategy

Source: CINAHL (EbscoHost CINAHL with full text)

Searched on: 29 November, 2010.

Saved as: n/a.

Results: 96.

Search:

(MH “Ethnic Groups + ”) OR (MH “Race Factors”) OR (MH “Minority Groups”).

AND.

(MH “Antipsychotic Agents + ”) OR (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Benperidol or Bromperidol or Butaperazine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clopenthixol or Clotiapine or Clozapine or Cyamemazine or Dixyrazine or DOGMATIL or Droperidol or Fluanisone or Flupentixol or Fluphenazine or Fluspirilene or Haloperidol or Levomepromazine or Levosulpiride or Loxapine or Melperone or Mesoridazine or Molindone or Moperone or Mosapramine or Olanzapine or Oxypertine or Paliperidone or Penfluridol or Perazine or Periciazine or Perphenazine or Pimozide or Pipamperone or Pipotiazine or Prochlorperazine or Promazine or Prothipendyl or Quetiapine or Remoxipride or Risperidone or Sertindole or Sulpiride or Sultopride or Thiopropazate or Thioproperazine or Thioridazine or Tiapride or Tiotixene or Trifluoperazine or Trifluperidol or Triflupromazine or Ziprasidon or Zotepine or Zuclopenthixol or Methotrimeprazine).

Limit to: Scholarly (Peer Reviewed) Journals.

Source: EMBASE (OvidSP; 1980 to 2010 Week 47)

Searched on: 1 December, 2010.

Saved as: ethnicity antipsychotics Joseph SR EMBASE.

Results: 1310.

Search:

  1. 1.

    exp neuroleptic agent/bd, ct, ad, cm, do, it, dt, ih, ia, ce, cv, dl, ig, im, na, ip, tl, iv, po, pa, pr, pe, pd, rc, sc, sb, li, tp, td

  2. 2.

    (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Benperidol or Bromperidol or Butaperazine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clopenthixol or Clotiapine or Clozapine or Cyamemazine or Dixyrazine or DOGMATIL or Droperidol or Fluanisone or Flupentixol or Fluphenazine or Fluspirilene or Haloperidol or Levomepromazine or Levosulpiride or Loxapine or Melperone or Mesoridazine or Molindone or Moperone or Mosapramine or Olanzapine or Oxypertine or Paliperidone or Penfluridol or Perazine or Periciazine or Perphenazine or Pimozide or Pipamperone or Pipotiazine or Prochlorperazine or Promazine or Prothipendyl or Quetiapine or Remoxipride or Risperidone or Sertindole or Sulpiride or Sultopride or Thiopropazate or Thioproperazine or Thioridazine or Tiapride or Tiotixene or Trifluoperazine or Trifluperidol or Triflupromazine or Ziprasidon or Zotepine or Zuclopenthixol or Methotrimeprazine).mp.

  3. 3.

    1 or 2

  4. 4.

    exp ethnic difference/or exp ethnic group/or exp “ethnic or racial aspects”/or exp race/or exp “ethnic, racial and religious groups”/or exp ethnicity/

  5. 5.

    3 and 4

  6. 6.

    limit 5 to (human and english language and year = ”1980 -Current”)

  7. 7.

    limit 6 to (article or journal or letter or report or “review”)

Source: International Pharmaceutical Abstracts (OvidSP; 1970 to November 2010)

Searched on: 29 November, 2010.

Saved as: ethnicity antipsychotics Joseph SR IPA.

Results: 84.

Search:

  1. 1.

    ethnic.mp. [mp = title, subject heading word, registry word, abstract, trade name/generic name]

  2. 2.

    (ethnic or ethnicity).hw.

  3. 3.

    race.hw.

  4. 4.

    1 or 2 or 3

  5. 5.

    Antipsychotic agents.hw.

  6. 6.

    (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Benperidol or Bromperidol or Butaperazine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clopenthixol or Clotiapine or Clozapine or Cyamemazine or Dixyrazine or DOGMATIL or Droperidol or Fluanisone or Flupentixol or Fluphenazine or Fluspirilene or Haloperidol or Levomepromazine or Levosulpiride or Loxapine or Melperone or Mesoridazine or Molindone or Moperone or Mosapramine or Olanzapine or Oxypertine or Paliperidone or Penfluridol or Perazine or Periciazine or Perphenazine or Pimozide or Pipamperone or Pipotiazine or Prochlorperazine or Promazine or Prothipendyl or Quetiapine or Remoxipride or Risperidone or Sertindole or Sulpiride or Sultopride or Thiopropazate or Thioproperazine or Thioridazine or Tiapride or Tiotixene or Trifluoperazine or Trifluperidol or Triflupromazine or Ziprasidon or Zotepine or Zuclopenthixol or Methotrimeprazine).ti,ab,hw,tn,rw.

  7. 7.

    5 or 6

  8. 8.

    4 and 7

  9. 9.

    limit 8 to (english language and human and year = ”1980-Current”)

Source: MEDLINE (1950 to Present with Daily Update) (OvidSP)

Searched on: 29 November 2010.

Saved as: ethnicity antipsychotics Joseph SR.

Results: 597.

Search:

  1. 1.

    ethnicity.mp.

  2. 2.

    exp ethnic groups/or exp african americans/or exp arabs/or exp asian americans/or exp gypsies/or exp hispanic americans/or exp mexican americans/or exp jews/

  3. 3.

    exp continental population groups/or exp african continental ancestry group/or exp african americans/or exp indians, central american/or exp indians, south american/or exp asian continental ancestry group/or exp asian americans/or exp european continental ancestry group/or exp oceanic ancestry group/

  4. 4.

    cross-cultural comparison/or exp cultural characteristics/or exp cultural diversity/or exp ethnology/

  5. 5.

    1 or 2 or 3 or 4

  6. 6.

    Antipsychotic agents/

  7. 7.

    Psychotic disorders/dt [drug therapy]

  8. 8.

    (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Benperidol or Bromperidol or Butaperazine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clopenthixol or Clotiapine or Clozapine or Cyamemazine or Dixyrazine or DOGMATIL or Droperidol or Fluanisone or Flupentixol or Fluphenazine or Fluspirilene or Haloperidol or Levomepromazine or Levosulpiride or Loxapine or Melperone or Mesoridazine or Molindone or Moperone or Mosapramine or Olanzapine or Oxypertine or Paliperidone or Penfluridol or Perazine or Periciazine or Perphenazine or Pimozide or Pipamperone or Pipotiazine or Prochlorperazine or Promazine or Prothipendyl or Quetiapine or Remoxipride or Risperidone or Sertindole or Sulpiride or Sultopride or Thiopropazate or Thioproperazine or Thioridazine or Tiapride or Tiotixene or Trifluoperazine or Trifluperidol or Triflupromazine or Ziprasidon or Zotepine or Zuclopenthixol or Methotrimeprazine).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

  9. 9.

    6 or 7 or 8

  10. 10.

    5 and 9

  11. 11.

    limit 10 to (english language and year = ”1980-Current”)

  12. 12.

    limit 11 to (classical article or clinical trial, all or comparative study or controlled clinical trial or evaluation studies or journal article or letter or meta analysis or multicenter study or randomized controlled trial or “review” or technical report or validation studies)

Source: PsycINFO (Ebsco)

Searched on: 29 November, 2010.

Saved as: n/a.

Results: 76.

Search:

  1. S1.

    DE “Racial and Ethnic Groups” OR DE “African Cultural Groups” OR DE “Arabs” OR DE “Asians” OR DE “Blacks” OR DE “Indigenous Populations” OR DE “Latinos/Latinas” OR DE “Romanies” OR DE “Whites” OR DE “Cross-Cultural Differences” OR DE “Racial and Ethnic Differences”

  2. S2.

    DE “Neuroleptic Drugs” OR DE “Aripiprazole” OR DE “Clozapine” OR DE “Molindone” OR DE “Nialamide” OR DE “Olanzapine” OR DE “Quetiapine” OR DE “Reserpine” OR DE “Risperidone” OR DE “Spiroperidol” OR DE “Sulpiride” OR DE “Tetrabenazine”

  3. S3.

    (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Benperidol or Bromperidol or Butaperazine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clopenthixol or Clotiapine or Clozapine or Cyamemazine or Dixyrazine or DOGMATIL or Droperidol or Fluanisone or Flupentixol or Fluphenazine or Fluspirilene or Haloperidol or Levomepromazine or Levosulpiride or Loxapine or Melperone or Mesoridazine or Molindone or Moperone or Mosapramine or Olanzapine or Oxypertine or Paliperidone or Penfluridol or Perazine or Periciazine or Perphenazine or Pimozide or Pipamperone or Pipotiazine or Prochlorperazine or Promazine or Prothipendyl or Quetiapine or Remoxipride or Risperidone or Sertindole or Sulpiride or Sultopride or Thiopropazate or Thioproperazine or Thioridazine or Tiapride or Tiotixene or Trifluoperazine or Trifluperidol or Triflupromazine or Ziprasidon or Zotepine or Zuclopenthixol or Methotrimeprazine)

  4. S4.

    S2 OR S3

  5. S5.

    S1 AND S4

Limiters—Scholarly (Peer Reviewed) Journals, 1980-Current.

Source: Web of Science (Thompson Reuters ISI Web of Knowledge)

Searched on: 29 November, 2010.

Saved as: n/a.

Results: 307.

Search:

  • Topic = (antipsychotic*)

  • Topic = (ethnic* OR racial OR race)

  • #2 AND #1

Refined by: document type = (article or letter or review) and languages = (english).

Timespan = all years. Databases = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH.

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Puyat, J.H., Daw, J.R., Cunningham, C.M. et al. Racial and ethnic disparities in the use of antipsychotic medication: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 48, 1861–1872 (2013). https://doi.org/10.1007/s00127-013-0753-4

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Keywords

  • Racial
  • Ethnic
  • Disparities
  • Antipsychotics
  • Schizophrenia