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Outpatient Prescriptions for Atypical Antipsychotics for African Americans, Hispanics, and Whites in the United States
Gail L. Daumit, MD, MHS;
Rosa M. Crum, MD, MHS;
Eliseo Guallar, MD, DrPH;
Neil R. Powe, MD, MPH, MBA;
Annelle B. Primm, MD, MPH;
Donald M. Steinwachs, PhD;
Daniel E. Ford, MD, MPH
Arch Gen Psychiatry. 2003;60:121-128.
Background New antipsychotic medications introduced during the past decade—clozapine (1990), risperidone (1994), olanzapine (1996), and quetiapine fumarate (1997)—offer a decrease in serious adverse effects compared with traditional antipsychotic medications, but at up to 10 times the cost. We examined whether ethnic minorities achieve access to these new advanced treatments.
Methods Using national data on physician office and hospital outpatient department visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1992 through 2000, we selected all patient visits at which an antipsychotic medication (atypical or traditional) was prescribed or continued and the patient was aged between 18 and 69 years. We performed a series of cross-sectional logistic regression analyses to determine the association of ethnic group and receipt of an atypical antipsychotic prescription over time, adjusted for potential confounders such as age, diagnosis, and health insurance type.
Results Antipsychotic medication was prescribed or continued in 5032 visits; 33% of overall visits involved an atypical antipsychotic prescription. During 1992 to 1994, the adjusted relative odds of receipt of an atypical antipsychotic prescription for African Americans was 0.50 (95% confidence interval [CI], 0.26-0.96) and for Hispanics was 0.43 (95% CI, 0.16-1.18) compared with whites. During 1995 to 1997, the odds of receipt of a prescription for atypical antipsychotics increased for African Americans (odds ratio [OR], 0.69; 95% CI, 0.54-0.85) and for Hispanics (OR, 0.84; 95% CI, 0.65-1.07) compared with whites; and during 1998 to 2000, the relative odds continued to increase for African Americans (OR, 0.88; 95% CI, 0.78-0.97) and for Hispanics (OR, 1.05; 95% CI, 0.92-1.16) compared with whites. For visits specified for psychotic disorders, receipt of atypical antipsychotics was still lower for African Americans by 1998 to 2000 (adjusted OR, 0.74; 95% CI, 0.61-0.89) compared with whites, while for Hispanics the relative odds was equivalent (adjusted OR, 1.05; 95% CI, 0.87-1.19).
Conclusion Early gaps between ethnic groups in receipt of atypical antipsychotic prescriptions decreased throughout the 1990s but persisted for African Americans with psychotic disorders.
From the Division of General Internal Medicine, Department of Medicine (Drs Daumit, Powe, Steinwachs, and Ford), and Welch Center for Prevention, Epidemiology & Clinical Research, The Johns Hopkins University School of Medicine, and Departments of Health Policy and Management (Drs Daumit, Powe, Primm, Steinwachs, and Ford), Psychiatry and Behavioral Sciences (Drs Crum, Primm, Steinwachs, and Ford), Mental Hygiene (Drs Crum and Steinwachs), and Epidemiology (Drs Crum, Guallar, Powe, and Ford), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
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