Poster Highlights Racial/Ethnic Disparities in LAI Use

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CONFERENCE REPORTER

Researchers found a statistically significant difference in racial and ethnic use of long-acting injectable antipsychotics (LAIs), according to a research poster presented at the 2023 American Psychiatric Association Annual Meeting.¹

The study leveraged data from the 2018-2019 Chronic Conditions Warehouse 100% Medicare Parts A, B, and D claims as well as summary files from the Centers for Medicare and Medicaid services. Inclusion criteria included at least 1 inpatient and/or at least 2 outpatient claims noting an ICD-10 diagnosis of schizophrenia as well as continuous fee-for-service coverage via Medicare Parts A, B, and D in 2018 and 2019. Patients with more than 1 inpatient and/or more than 2 outpatients claims noting a bipolar diagnosis were excluded. To control for sociodemographic and clinical history variables, logistic regression models were used to calculate adjusted outcomes by race and ethnicity categories.

Patients (n=210,686) were at least 18 years old, with a mean age of 56.1 years. A slight majority were male (60.6%) and white (66.4%). Approximately one quarter (22.6%) of the patients used an LAI, with the majority (66.4%) receiving second generation LAIs. Although initial data found large differences between any LAI use among white, Black, Hispanic, and other patients (19.3%, 30.7%, 26.0, and 25.8%, respectively), the differences narrowed substantially after the adjustment was made (22.2%, 23.5%, 23.0%, and 229%, respectively). Differences remained more substantial when considering second generation LAI use, with lower rates of use among Black patients (601%) and Hispanic patients (64.9%) versus white patients (69.9%). Subgroup and sensitivity analyses supported these findings.

The investigators noted the study had some limitations, including lack of nuanced clinical information in claims data and the findings’ generalizability to fee-for-service Medicare populations. The study was funded by Janssen Scientific Affairs, LLC.

“Given that several [second generation] LAIS are now available with longer dosing intervals (every 2, 3, or 6 months) that may facilitate improved antipsychotic adherence, future research should examine reasons for these disparities and could assist in the development of appropriate interventions,” the researchers concluded. “Future research should examine reasons for these disparities and their impact on clinical and economic outcomes.”

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Reference

1. Patel C, Benson C, Li P, et al. Racial/Ethnic Disparities in Long-Acting Injectable Antipsychotic Use in a National Sample of Medicare Beneficiaries With Schizophrenia. Poster presented at the 2023 American Psychiatric Association Annual Meeting; May 20-24, 2023. San Francisco, CA.