BACKGROUND: Current evidence suggests lower treatment rates among racial minorities compared to White patients for many medical conditions. However, inequities in pharmacological treatment among insomnia patients remains unclear.

OBJECTIVES: Examine racial disparities in pharmacological treatment among patients with electronic health record (EHR)-documented insomnia diagnosis.

METHODS: Between 1/1/2010-12/31/2019, a retrospective cohort of patients (≥18 years) with insomnia diagnosis was identified in the Indiana Network for Patient Care (INPC). Eligible patients had at least one healthcare encounter per year during the study period. Patients with prior insomnia diagnoses or FDA-approved insomnia medications were excluded. Insomnia patients were followed from diagnosis date until 12/31/2019 to determine receipt of FDA-approved medication for insomnia. Age, gender, race, and ethnicity were extracted from EHR. National area deprivation index (ADI) percentile was derived from the Neighborhood Atlas. Multivariable logistic regression was used to determine association between socio-demographic factors and receipt of FDA-approved insomnia medications.

RESULTS: 3,263 patients with insomnia diagnosis were included; 34.3% male, 36.1% ≥65 years, and 83.6% White. The relationship between receipt of FDA-approved insomnia medications and socio-demographic factors did not differ by race or ethnicity (interaction terms: p >0.05); however, Blacks had significantly lower odds of receiving an FDA-approved pharmacological treatment for insomnia than Whites (adjusted odds ratio [aOR] = 0.55, 95% CI 0.38-0.78). The odds of receiving FDA-approved insomnia medications did not different by gender (aOR=1.18, 95% CI 0.93-1.48) or ethnicity (aOR = 0.75, 95% CI 0.26-2.14).

CONCLUSIONS: Among high healthcare utilizers, Black patients had lower odds of receiving a prescription for an FDA-approved medication after EHR-documented insomnia diagnosis than White patients. The disproportionately lower odds of FDA-approved medications among Blacks versus Whites even after controlling for ADI, age, and gender differences underscores the need for greater clinical awareness of factors that may contribute towards racially biased treatment decisions to promote equitable care.