Identifying Racial Disparities in Clozapine Prescriptions Among Schizophrenia Patients using Data from Electronic Health Records

ObjectiveThis study sought to assess the demographic factors that alter the likelihood of being prescribed clozapine. The primary hypothesis is that African American patients are less likely to be prescribed Clozapine than White and other racial groups. Additionally, this study aims to expand on earlier studies of clozapine by examining how multiple variables, especially social determinants of health, gender, rurality, and care patterns affect the rates at which clozapine is prescribed. MethodsThis observational study examines the racial disparities and other factors associated with receiving a clozapine prescription for patients with a schizophrenia diagnosis using structured data in the Electronic Health Records (EHR) from a multi-facility health system from 10/1/2015 - 11/30/2021. Bivariate analysis, multiple logistic regression, and sensitivity analysis tests were performed to determine which factors differed significantly between the group of patients who were prescribed clozapine and those who were not. ResultsResults showed that being white and having a higher socioeconomic income was associated with an increased clozapine prescription rate, while gender, rurality, age at first diagnosis, and ethnicity did not influence prescription likelihood. Increased treatment length was also associated with a greater likelihood of being prescribed clozapine. ConclusionAfrican American patients are over-diagnosed with schizophrenia and under-prescribed clozapine compared to Caucasians after controlling for the variables associated with demographics, social determinants of health, and care access patterns. Future research is needed to understand and disentangle the biological, clinical, administrative, and societal causes behind the disparity in clozapine treatment.