Longitudinal Racial/Ethnic Disparities in Antimanic Medication Use in Bipolar-I Disorder
Longitudinal Racial/Ethnic Disparities in Antimanic Medication Use in Bipolar-I Disorder
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DOI：
10.1097/mlr.0b013e3181adcc4f
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发表时间：
2009-12-01
期刊：
影响因子：
3
通讯作者：
McGuire, Thomas G.
中科院分区：
文献类型：
--
作者：
Busch, Alisa B.;Huskamp, Haiden A.;McGuire, Thomas G.
目的：要检查种族/民族的纵向差异，在抗躁狂药物的使用与成人双相I disorder.Methods：观察性研究，使用行政数据从佛罗里达的医疗补助计划，1997年7月至2005年调整，登记诊断为双相I障碍（N = 13,497人，126,413人宿舍）。我们检查了在特定季度内接受以下药物之一的可能性：（1）任何抗躁狂药物（抗精神病药或情绪稳定剂）或不使用，（2）情绪稳定剂，抗精神病药单药治疗，或两者都不使用。二项和多项逻辑回归模型预测了人种/种族与处方填充之间的关联，并对临床和人口统计学特征进行了调整。队列指标的一年，登记者符合研究标准，包括占队列effects.Results：平均在所有队列和季度，与白人相比，黑人有较低的几率填补任何抗躁狂和情绪稳定剂处方具体（40%-49%和47%-63%，分别），但类似的几率填补抗精神病药物单药治疗处方。Bonferroni调整后，与白人相比，有没有统计学上的显着差异，西班牙裔在填写处方的任何，或特定的抗躁狂药物。结论：抗躁狂药物的使用率低，无论种族/民族。然而，我们发现黑人与白人在抗躁狂药物的使用上存在差异，并且这些差异随着时间的推移而持续存在。我们没有发现西班牙裔白人的差异。质量改进工作应集中在所有的双相情感障碍患者，但应特别注意了解黑人药物使用的差异。
Objective: To examine racial/ethnic longitudinal disparities in antimanic medication use among adults with bipolar-I disorder.Methods: Observational study using administrative data from Florida's Medicaid program, July 1997 to tune 2005, for enrollees diagnosed with bipolar-I disorder (N = 13,497 persons; 126,413 person-quarters). We examined the likelihood of receiving one of the following during a given quarter: (1) any antimanic agent (antipsychotic or mood stabilizer) or none, and (2) mood stabilizers, antipsychotic monotherapy, or neither. Binary and multinomial logistic regression models predicted the association between race/ethnicity and prescription fills, adjusting for clinical and demographic characteristics. Cohort indicators for year that the enrollee met study criteria were included to account for cohort effects.Results: Averaging over all cohorts and quarters, compared with whites, blacks had lower odds of filling any antimanic and mood stabilizer prescriptions specifically (40%-49% and 47%-63%, respectively), but similar odds of filling prescriptions for antipsychotic monotherapy. After Bonferroni adjustment, compared with whites, there were no statistically significant disparities for Hispanics in filling prescriptions for any, or specific antimanic medications.Conclusions: Rates of antimanic medication use were low regardless of race/ethnicity. However, we found disparities in antimanic medication use for blacks compared with whites and these disparities persisted over time. We found no Hispanic-white disparities. Quality improvement efforts should focus on all individuals with bipolar disorder, but particular attention should be paid to understanding disparities in medication use for blacks.