title: Persistence of racial disparities in prescription of first-generation antipsychotics in the USA.
abstract: OBJECTIVE
  The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits.
  
  
  METHODS
  The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS.
  
  
  RESULTS
  Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS.
  
  
  CONCLUSIONS
  Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.
authors.affiliation: Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Cook
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Reeves
authors.affiliation: Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Teufel
authors.affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.|Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.|Rocky Mountain MIRECC, Denver, CO, USA.
authors.forename: Teodor T
authors.initials: TT
authors.lastname: Postolache
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001590:Benztropine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001590:Benztropine
keywords: antipsychotics; pharmacoepidemiology; prescribing patterns; racial disparities