Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3048 — Race, Polypharmacy, and Metabolic Risk Factors in Veterans with Bipolar Disorder

Author List:
Kilbourne AM (CHERP, Pittsburgh)
Good CB (CHERP, Pittsburgh)
Zeber JE (VERDICT, San Antonio)
Copeland LA (VERDICT, San Antonio)
Xu X (CHERP, Pittsburgh)
Fine MJ (CHERP, Pittsburgh)
Pincus HA (University of Pittsburgh)

Objectives:
Bipolar disorder is a chronic condition associated with substantial health care costs and functional impairment. Polypharmacy (i.e., multiple medications to treat bipolar disorder), may increase the risk of adverse outcomes, including metabolic-related conditions (e.g., obesity, dyslipidemia). While evidence suggests that African-Americans are less likely to receive adequate pharmacotherapy for depression and schizophrenia, similar differences for bipolar disorder have not been explored. The aim of this study was to assess racial differences in pharmacotherapy and metabolic risk factors among a cohort of patients with bipolar disorder.

Methods:
Patients from the Continuous Improvement for Veterans in Care-Mood Disorders study on bipolar disorder completed baseline assessments of demographic and behavioral factors. Use of mood stabilizers, antipsychotics, and antidepressants; lab tests; and ICD-9 diagnoses of metabolic-related conditions were ascertained from administrative data. Multivariable logistic regression analyses determined whether race was independently associated with medication, polypharmacy (receiving a mood stabilizer, atypical antipsychotic, and antidepressant), receipt of mood stabilizer toxicity assay, receipt of cholesterol assay, and medical diagnoses within a 12-month period.

Results:
Of 253 patients, 11% were African-American, and the mean age was 49 years. Overall, 81% were prescribed a mood stabilizer, 51% an atypical antipsychotic, and 31% were prescribed polypharmacy. The majority of patients prescribed atypical antipsychotics received a cholesterol test (74%); 82% prescribed mood stabilizers received a toxicity test. Medical diagnoses included obesity (26%), dyslipidemia (29%), hypertension (36%), and diabetes (15%). After adjusting for age, gender, living alone, non-VA healthcare, and substance abuse, African-Americans were less likely than non-African-Americans to receive mood stabilizers (OR=.29,p=.005), no less likely to receive atypical antipsychotics, cholesterol or mood stabilizer assays, but more likely diagnosed with obesity (OR=2.27,p=.03).

Implications:
Polypharmacy was common among patients with bipolar disorder. While the majority received appropriate drug toxicity monitoring, a substantial proportion were diagnosed with metabolic-related conditions. African-Americans with bipolar disorder were less likely prescribed mood stabilizers, considered first-line treatment for bipolar disorder.

Impacts:
Bipolar disorder is one of the most costly psychiatric conditions, and ranks among the top ten in disability in the WHO’s Global Burden of Disease. Understanding variations in polypharmacy and metabolic syndrome risk can inform intervention strategies and potentially reduce healthcare disparities.