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Research Article| Volume 9, ISSUE 2, P128-135, April 2023

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Racial disparities in the pharmacological treatment of insomnia: A time-to-event analysis using real-world data

  • Emma Holler
    Correspondence
    Corresponding author: Emma Holler, MPH, 1075 East 7th Street, Bloomington, IN 47405, USA. Tel.: 812-855-1561.
    Affiliations
    Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
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  • Noll L. Campbell
    Affiliations
    College of Pharmacy and Health Sciences, Purdue University, West Lafayette, Indiana, USA

    Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA

    Center for Healthcare Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA
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  • Malaz Boustani
    Affiliations
    Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA

    Center for Healthcare Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA

    Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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  • Paul Dexter
    Affiliations
    Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
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  • Zina Ben Miled
    Affiliations
    Department of Electrical and Computer Engineering, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
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  • Arthur Owora
    Affiliations
    Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
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Published:February 27, 2023DOI:https://doi.org/10.1016/j.sleh.2023.02.002

      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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