title: The effect of race-ethnicity and geography on adoption of innovations in the treatment of schizophrenia.
abstract: OBJECTIVE
  This study evaluated the effect of race-ethnicity and geography on the adoption of a pharmacological innovation (long-acting injectable risperidone [LAIR]) among Medicaid beneficiaries with schizophrenia as well as the contribution of geographic location to observed racial-ethnic disparities.
  
  
  METHODS
  The data source was a claims data set from the Florida Medicaid program for the 2.5-year period that followed the launch of LAIR in the U.S. market. Study participants were beneficiaries with schizophrenia who had filled at least one antipsychotic prescription during the study period. The outcome variable was any use of LAIR; model variables were need indicators and random effects for 11 Medicaid areas, which are multicounty units used by the Medicaid program to administer benefits. Adjusted probability of use of LAIR for blacks and Latinos versus whites was estimated with logistic regression models.
  
  
  RESULTS
  The study cohort included 13,992 Medicaid beneficiaries: 25% of the cohort was black, 37% Latino, and 38% white. Unadjusted probability of LAIR use was lower for Latinos than whites, and use varied across the state's geographic areas. Adjustment for need confirmed the unadjusted finding of a disparity between Latinos and whites (odds ratio=.58, 95% confidence interval=.49-.70). The inclusion of geographic location in the model eliminated the Latino-white disparity but confirmed the unadjusted finding of geographic variation in adoption.
  
  
  CONCLUSIONS
  Within a state Medicaid program, the initial finding of a disparity between Latinos and whites in adopting LAIR was driven by geographic disparities in adoption rates and the geographic concentration of Latinos in a low-adoption area. Possible contributors and implications of these results are discussed.
authors.affiliation: RAND Corporation, 4570 Fifth Ave., Suite 600, Pittsburgh, PA 15213, USA. mhorvitz@rand.org
authors.forename: Marcela
authors.initials: M
authors.lastname: Horvitz-Lennon
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D016001:Confidence Intervals; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D005260:Female; D005431:Florida; D062306:Geography, Medical; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D016017:Odds Ratio; D018967:Risperidone / Q000008:administration & dosage*; D012559:Schizophrenia / Q000188:drug therapy* / Q000208:ethnology*; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone