Disparities in Antipsychotic Prescribing Among the US Medicare Population
Author(s)
Yvonne Yang, MD, PhD1, Justin Nedzesky, PharmD, MS2, Samantha E. Clark, PhD, MHS3, Frankie Berger, MSc2, Eric S. Zuk, MBA3, Avery Mohan, BA3, Zachary Marcum, PharmD, PhD3, Vanessa Fisher, MPA2, Michael Serbin, PharmD, MS2, Jamie Hamill, DNP, APRN, PMHNP-BC2, Dawn Vanderhoef, PhD, DNP, PMHNP, FAANP2, Morgan Bron, PharmD, MS2, Adys Mendizabal, MD, MS1.
1University of California, Los Angeles (UCLA), Los Angeles, CA, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3Medicus Economics, Milton, MA, USA.
1University of California, Los Angeles (UCLA), Los Angeles, CA, USA, 2Neurocrine Biosciences, Inc, San Diego, CA, USA, 3Medicus Economics, Milton, MA, USA.
OBJECTIVES: Antipsychotics remain a primary treatment option for many psychiatric conditions; however, prolonged exposure, especially to first-generation antipsychotics, is associated with increased risk of drug-induced movement disorders, including tardive dyskinesia. This study builds upon previous analyses suggesting racial and ethnic disparities in antipsychotic prescribing by examining whether these disparities persist across broader health equity measures in the Medicare population.
METHODS: We conducted a retrospective cohort study using 100% Medicare claims data to identify beneficiaries with any antipsychotic prescription drug claim from 2017-2022. We identified demographic and clinical factors associated with incident first- versus second-generation antipsychotic selection using separately specified logistic regression models. Fitted logistic regression models were used to estimate predicted probabilities and average marginal effects via recycled predictions. Standard errors and 95% confidence intervals (CIs) were generated using bootstrap resampling.
RESULTS: Of 2,677,242 incident antipsychotic users, 6% (n=161,485) were prescribed first-generation antipsychotics and 94% (n=2,515,757) were prescribed second-generation antipsychotics. Approximately 26% (n=687,139) were under 65 years of age at incident antipsychotic prescription, with 41% dually eligible for Medicare and Medicaid. The risk of incident first-generation antipsychotic treatment was estimated to be 39% higher (95% CI: 37%-41%) among Black versus White patients, 116% higher (95% CI: 100%-137%) among patients treated in long-term care (LTC) versus community mental health center settings, and 36% higher (95% CI: 34%-38%) among dual-eligible versus Medicare-only patients. Conversely, Latino patients were 17% less likely (95% CI: 15%-18%) to initiate first-generation antipsychotics versus White patients.
CONCLUSIONS: In this study, while less commonly prescribed, incident first-generation antipsychotic use was significantly more likely among Black, LTC, and dual-eligible patients, and less likely among Latino patients. Results highlight the increased likelihood of higher-risk antipsychotic selection across multiple vulnerable populations. Future studies are needed to understand the implications, such as risk of drug-induced movement disorders like tardive dyskinesia, among these groups.
METHODS: We conducted a retrospective cohort study using 100% Medicare claims data to identify beneficiaries with any antipsychotic prescription drug claim from 2017-2022. We identified demographic and clinical factors associated with incident first- versus second-generation antipsychotic selection using separately specified logistic regression models. Fitted logistic regression models were used to estimate predicted probabilities and average marginal effects via recycled predictions. Standard errors and 95% confidence intervals (CIs) were generated using bootstrap resampling.
RESULTS: Of 2,677,242 incident antipsychotic users, 6% (n=161,485) were prescribed first-generation antipsychotics and 94% (n=2,515,757) were prescribed second-generation antipsychotics. Approximately 26% (n=687,139) were under 65 years of age at incident antipsychotic prescription, with 41% dually eligible for Medicare and Medicaid. The risk of incident first-generation antipsychotic treatment was estimated to be 39% higher (95% CI: 37%-41%) among Black versus White patients, 116% higher (95% CI: 100%-137%) among patients treated in long-term care (LTC) versus community mental health center settings, and 36% higher (95% CI: 34%-38%) among dual-eligible versus Medicare-only patients. Conversely, Latino patients were 17% less likely (95% CI: 15%-18%) to initiate first-generation antipsychotics versus White patients.
CONCLUSIONS: In this study, while less commonly prescribed, incident first-generation antipsychotic use was significantly more likely among Black, LTC, and dual-eligible patients, and less likely among Latino patients. Results highlight the increased likelihood of higher-risk antipsychotic selection across multiple vulnerable populations. Future studies are needed to understand the implications, such as risk of drug-induced movement disorders like tardive dyskinesia, among these groups.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P18
Topic
Health Service Delivery & Process of Care
Disease
SDC: Mental Health (including addition), SDC: Neurological Disorders