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Ethnic inequalities in treatment with clozapine

Published online by Cambridge University Press:  01 September 2022

D. Fonseca De Freitas*
Affiliation:
King’s College London & University of Oxford College London, Psychological Medicine & Department Of Psychiatry And Nuffield Department Of Primary Care Health Sciences, London, United Kingdom
I. Patel
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department Of Psychological Medicine, London, United Kingdom
G. Kadra-Scalzo
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department Of Psychological Medicine, London, United Kingdom
M. Pritchard
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department Of Psychological Medicine, London, United Kingdom
H. Shetty
Affiliation:
South London and Maudsley NHS Foundation Trust, Maudsley Biomedical Research Centre, London, United Kingdom
M. Broadbent
Affiliation:
South London and Maudsley NHS Foundation Trust, Maudsley Biomedical Research Centre, London, United Kingdom
R. Patel
Affiliation:
King’s College London, Academic Psychiatry, London, United Kingdom
J. Downs
Affiliation:
King’s College London, Academic Psychiatry, London, United Kingdom
A. Segev
Affiliation:
Tel Aviv University, Sackler Faculty Of Medicine, Tel Aviv-Yafo , Israel
M. Khondoker
Affiliation:
University of East Anglia, Norwich Medical School, Norwich, United Kingdom
J. Maccabe
Affiliation:
King’s College London, Academic Psychiatry, London, United Kingdom
K. Bhui
Affiliation:
Universiy of Oxford, Dept Of Psychiatry And Nuffield Dept Of Primary Care Health Sciences, Oxford, United Kingdom
R. Hayes
Affiliation:
Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Department Of Psychological Medicine, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Ethnic disparities in treatment with clozapine, the antipsychotic recommended for treatment-resistant schizophrenia (TRS), have been reported. However, these investigations frequently suffer from potential residual confounding. For example, few studies have restricted the analyses to TRS samples and none has controlled for benign ethnic neutropenia.

Objectives

This study investigated if service-users’ ethnicity influenced clozapine prescription in a cohort of people with TRS.

Methods

Information from the clinical records of South London and Maudsley NHS Trust was used to identify a cohort of service-users with TRS between 2007 and 2017. In this cohort, we used logistic regression to investigate any association between ethnicity and clozapine prescription while adjusting for potential confounding variables, including sociodemographic factors, psychiatric multimorbidity, substance use, benign ethnic neutropenia, and inpatient and outpatient care received.

Results

We identified 2239 cases that met the criteria for TRS. Results show that after adjusting for confounding variables, people with Black African ethnicity had half the odds of being treated with clozapine and people with Black Caribbean or Other Black background had about two-thirds the odds of being treated with clozapine compared White British service-users. No disparities were observed regarding other ethnic groups, namely Other White background, South Asian, Other Asian, or any other ethnicity.

Conclusions

There was evidence of inequities in care among Black ethnic groups with TRS. Interventions targeting barriers in access to healthcare are recommended.

Disclosure

During the conduction of the study, DFdF, GKS, and RH received funds from the NIHR Maudsley Biomedical Research Centre. For other activities outside the submitted work, DFdF received research funding from the UK Department of Health and Social Care, Janss

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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