Black and Asian patients with dementia experience race-based disparities in prescriptions for psychotropic drug treatments, according to study data published in Clinical Epidemiology. Compared with their peers, Asian patients with dementia were less likely to be prescribed antidementia drugs, and they received these drugs for fewer days per year. For patients treated with antipsychotics, Asian and black individuals were prescribed drugs for longer periods than white patients.
Investigators at University College London and King’s College London in the United Kingdom abstracted medical records data from The Health Improvement Network (THIN) database for 2014 to 2016. THIN includes data from 744 clinical practices comprising 15.6 million patients. The study included patients aged 50 to 105 years with at least 6 months of follow-up data. Patients with dementia were identified per diagnostic codes recorded in the THIN database, and ethnicity information was ascertained by self-report. The primary outcome was receipt of a prescription for an anticholinergic, antipsychotic, anxiolytic/hypnotic, or dementia drug. To assess the relationship between ethnicity and prescribing outcomes, the investigators performed multivariable Poisson regressions adjusted for 10-year age strata, sex, and Townsend deprivation index score.
The final study cohort comprised 53,718 patients with dementia (mean age, 81.7 years; 36.1% men; 96.6% white) and 1,648,889 patients without dementia. Asian patients with dementia were less likely to be prescribed an antidementia drug than white patients with dementia (prevalence rate ratio, 0.86; 95% CI, 0.76-0.98). Among patients who received an antidementia drug, those who were Asian received an average of 15 fewer prescription days per year compared with white patients (258 vs 273 days).
No ethnic group was more likely to receive an antipsychotic prescription among patients with dementia. However, Asian and black patients received 17 and 27 more antipsychotic prescription days per year, respectively, than white patients. Compared with Asian and white patients, black patients were significantly less likely to receive a prescription for anxiolytics/hypnotics (prevalence rate ratio, 0.60; 95% CI, 0.44-0.80). The duration of anxiolytic prescriptions did not vary between ethnic groups. In analyses unadjusted for cardiovascular comorbidities, Asian patients were more likely to receive anticholinergic drugs (prevalence rate ratio, 1.43; 95% CI, 1.19-1.73). Asian and black individuals without dementia were significantly less likely overall to receive any psychotropic drugs than their white counterparts.
These data illustrate race-based trends in psychotropic prescribing among patients with dementia. The potential underprescribing of antidementia drugs for Asian patients may be of particular importance. As study limitations, the investigators noted that the patient cohorts were overwhelmingly white. In addition, race data were missing for a significant proportion of THIN database cases.
“We do not know whether the increased duration of antipsychotic prescribing in Black and Asian ethnic groups is sufﬁcient to cause harm, but it is concerning and reﬂects other large studies in the developed world,” the researchers concluded, “Campaigns such as Choosing Wisely to reduce antipsychotic prescribing in dementia are not being implemented sufﬁciently in any ethnic group.”
Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures
Jones ME, Petersen I, Walters K, et al. Differences in psychotropic drug prescribing between ethnic groups of people with dementia in the United Kingdom. Clin Epidemiol. 2020;12:61-71.