Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register.

Autor: Wellesley Wesley E; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Patel I; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Kadra-Scalzo G; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Pritchard M; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK., Shetty H; South London and Maudsley NHS Foundation Trust, London, UK., Broadbent M; South London and Maudsley NHS Foundation Trust, London, UK., Segev A; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel., Patel R; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK., Downs J; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK., MacCabe JH; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK., Hayes RD; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., de Freitas DF; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: Daniela.Fonseca_de_Freitas@kcl.ac.uk.
Jazyk: angličtina
Zdroj: Schizophrenia research [Schizophr Res] 2021 Jun; Vol. 232, pp. 68-76. Date of Electronic Publication: 2021 May 19.
DOI: 10.1016/j.schres.2021.05.006
Abstrakt: Background: Gender disparities in treatment are apparent across many areas of healthcare. There has been little research into whether clozapine prescription, the first-line treatment for treatment-resistant schizophrenia (TRS), is affected by patient gender.
Methods: This retrospective cohort study identified 2244 patients with TRS within the South London and Maudsley NHS Trust, by using a bespoke method validated against a gold-standard, manually coded, dataset of TRS cases. The outcome and exposures were identified from the free-text using natural language processing applications (including machine learning and rules-based approaches) and from information entered in structured fields. Multivariable logistic regression was carried out to calculate the odds ratios for clozapine prescription according to patients' gender, and adjusting for numerous potential confounders including sociodemographic, clinical (e.g., psychiatric comorbidities and substance use), neutropenia, functional factors (e.g., problems with occupation), and clinical monitoring.
Results: Clozapine was prescribed to 77% of the women and 85% of the men with TRS. Women had reduced odds of being prescribed clozapine as compared to men after adjusting for all factors included in the present study (adjusted OR: 0.66; 95% CI 0.44-0.97; p = 0.037).
Conclusion: Women with TRS are less likely to be prescribed clozapine than men with TRS, even when considering the effects of multiple clinical and functional factors. This finding suggests there could be gender bias in clozapine prescription, which carries ramifications for the relatively poorer care of women with TRS regarding many outcomes such as increased hospitalisation, mortality, and poorer quality of life.
Competing Interests: Declaration of competing interest RDH and HS have received research funding from Roche, Pfizer, Janssen and H. Lundbeck A/S. GKS and DFdF have received research funding from Janssen and H. Lundbeck A/S. JHM has received research funding from H. Lundbeck A/S. RP has received research funds from Janssen and consultancy fees from Induction Healthcare and Holmusk. AS and EWW have no conflicts of interest to report.
(Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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