Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom
Differences in Psychotropic Drug Prescribing Between Ethnic Groups of People with Dementia in the United Kingdom
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DOI：
10.2147/clep.s222126
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Cooper, Claudia
中科院分区：
文献类型：
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作者：
Jones, Mary Elizabeth;Petersen, Irene;Cooper, Claudia
目的：验证以下假设：英国少数民族痴呆症患者服用的抗痴呆药物较少，而与危害相关的精神药物和抗胆碱能药物较多。患者和方法：我们分析了来自健康改善网络(Thin)数据库的英国初级保健电子健康记录(2014-2016)，比较了白人、黑人和亚裔痴呆症患者的精神药物处方开始和持续时间。我们在非痴呆症患者(50岁以上)中重复分析，以探索发现的任何差异是否反映了一般老年人口的处方模式，还是特定于痴呆症患者。结果：我们包括53,718名痴呆症患者和1,648,889名非痴呆症患者。在痴呆症患者中，与白人群体相比，亚裔人群在潜在指示时不太可能得到抗痴呆症药物的处方(调整后的患病率比0.86(95%可信区间0.76-0.98))，并且平均少接受15天/年的治疗。与白人组相比，亚裔和黑人痴呆症患者并不更有可能服用抗精神病药物，但那些已经服用抗精神病药物的人/年分别多开了17天和27天(190.8(179.6-199.1)天和200.7(191.1-206.5)天)。黑人不太可能被开出抗焦虑药物/催眠药(0.60(0.44-0.8))，但开这些药物的时间在不同种族之间是相似的。在未调整心血管并发症的分析中，亚洲人更有可能服用抗胆碱能药物(1.43(1.19-1.73))。在非痴呆症患者中，与白人相比，亚裔和黑人群体更不可能被开出精神药物。结论：在痴呆症患者中，亚裔群体接受的潜在益处对症治疗较少，亚裔和黑人群体被开抗精神病药物的时间比白人群体长。我们的发现可能表明护理不平等。
Purpose: To test hypotheses that minority ethnic people with dementia in the UK receive fewer anti-dementia drugs and more psychotropic and anticholinergic drugs associated with harms.Patients and Methods: We analyzed UK primary care electronic health records from The Health Improvement Network (THIN) database (2014-2016), comparing psychotropic drug prescribing initiation and duration between people with dementia from White, Black, and Asian ethnic groups. We repeated analyses in people (aged 50+) without dementia, to explore whether any differences found reflected prescribing patterns in the general older population, or were specific to dementia.Results: We included 53,718 people with and 1,648,889 people without dementia. Among people with dementia, compared to White ethnic groups, Asian people were less likely to be prescribed anti-dementia drugs when they were potentially indicated (adjusted prevalence rate ratio 0.86 (95% Confidence Interval 0.76-0.98)), and received them for on average 15 days/year less. Compared to White groups, Asian and Black individuals with dementia were no more likely to take an antipsychotic drug, but those that had were prescribed them for 17 and 27 days/year more, respectively (190.8 (179.6-199.1) and 200.7 (191.1-206.5) days). Black people were less likely to be prescribed anxiolytics/hypnotics (0.60 (0.44-0.8)), but the duration these drugs were prescribed was similar across ethnic groups. Asian people were more likely to be prescribed anticholinergic drugs (1.43 (1.19-1.73)), in analyses unadjusted for cardiovascular comorbidities. Among people without dementia, those in the Asian and Black ethnic groups were less likely to be prescribed psychotropic drugs, relative to people from White groups.Conclusion: Among people with dementia, Asian groups received less potentially beneficial symptomatic treatments, and Asian and Black groups were prescribed antipsychotic drugs for longer than White ethnic groups. Our findings may indicate care inequalities.