Abstract
Objective
Examine the association between race and time to pharmacologic treatment of insomnia
in a large multi-institutional cohort.
Methods
Retrospective analysis of electronic medical records from a regional health information
exchange. Eligible patients included adults with at least one healthcare visit per
year from 2010 to 2019, a new insomnia diagnosis code during the study period, and
no prior insomnia diagnosis codes or medications. A Cox frailty model was used to
examine the association between race and time to an insomnia medication after diagnosis.
Results
In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%)
Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of
Other race patients received an order for a Food and Drug Administration-approved
insomnia medication after diagnosis compared with 13.5% of White patients. Black patients
were significantly less likely to have an order for a Food and Drug Administration-approved
insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73),
and patients reporting Other race were less likely to have received an order at 2
(aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79),
and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed
in a sensitivity analysis including off-label medications.
Conclusions
Patients belonging to racial minority groups are less likely to be prescribed an insomnia
medication than White patients after accounting for sociodemographic and clinical
factors. Further research is needed to determine the extent to which patient preferences
and physician perceptions affect these prescribing patterns and investigate potential
disparities in nonpharmacologic treatment.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 9,
2023
Received in revised form:
December 19,
2022
Received:
September 12,
2022
Identification
Copyright
© 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved. All rights reserved.
