2064. Racial Disparity in the Use of Atypical Antipsychotic Medications: Is It Still a Problem?
LA Copeland, Center for Practice Management and Outcomes Research, JE Zeber, Serious Mental Illness Treatment Research and Evaluation Center, M Valenstein, Center for Practice Management and Outcomes Research, FC Blow, Serious Mental Illness Treatment Research and Evaluation Center

Objectives: Several studies have reported racial disparities in the diagnosis and treatment of psychiatric disorders; specifically, African-American patients with schizophrenia were less likely to receive newer atypical antipsychotic agents than white patients. Reasons suggested for this disparity include metabolic differences, fewer trials of antipsychotic agents, and cultural misunderstanding of symptoms of non-white patients. Atypicals are more expensive but patients using them report better quality of life. The atypical clozapine is uniquely effective for refractory schizophrenia and possibly for dually diagnosed patients as well. This study assesses the current state of antipsychotic prescription practices vis-à-vis race among VA patients.

Methods: We examined pharmacy records over a 12-month period for all veterans with schizophrenia and antipsychotic prescriptions in fiscal year 1999. Among 69,787 veterans, 26,000 (37%) had prescriptions for atypical antipsychotics, 27,491 (39%) for conventional antipsychotics, and 16,296 (23%) for both atypical and conventional antipsychotics. The sample was 61% white (n=42,800), 30% African-American (n=21,032), and 9% Hispanic (n=5,955).

Results: Use of any atypical agent during the year exhibited a significant association with race/ethnicity. Unexpectedly, this finding was not related to being African-American. Hispanic veterans were less likely to receive atypical agents; whites were slightly less likely not to. Looking at specific medications, we found that African-American (OR=0.3) and Hispanic (OR=0.3) veterans were much less likely to receive clozapine than were white veterans. African-American patients with schizophrenia were also less likely to receive olanzapine (OR=0.9) while Hispanic patients were more so (OR=1.2).

Conclusions: Ethnic disparity in the prescription of atypical vs. conventional antipsychotics is apparent for specific agents among African-American and Hispanic veterans with schizophrenia. The prescription of clozapine, first choice for refractory cases, does vary greatly by race/ethnicity and may represent a lapse in race-blind treatment practices, or may reflect concerns over serious side effects such as white blood cell or blood glucose fluctuations.

Impact: This study offers a progress report on the VA's effort to address race-based treatment disparities among veterans with schizophrenia. Treatment of Hispanic veterans with schizophrenia merits further investigation, whereas broad disparities formerly noted between African-American and white veterans appear to now be limited to specific drugs.