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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References
- Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing, Washington, DC2013
- Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, criteria: results from the America insomnia survey.Biol Psychiatry. 2011; 69: 592-600
- Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.J Family Med Prim Care. 2016; 5: 780-784https://doi.org/10.4103/2249-4863.201153
- Socioeconomic status and insomnia.J Abnorm Psychol. 2005; 114: 111-118https://doi.org/10.1037/0021-843x.114.1.111
- Insomnia, excessive daytime sleepiness, anxiety, depression and socioeconomic status among customer service employees in Canada.Sleep Sci. 2020; 13: 54-64https://doi.org/10.5935/1984-0063.20190133
- Sleep and its relationship to racial and ethnic disparities in cardiovascular disease.Curr Cardiovasc Risk Rep. 2013; 7 (PMID: 24244756; PMCID: PMC3824366)https://doi.org/10.1007/s12170-013-0330-0
- Are sleep patterns influenced by race/ethnicity - a marker of relative advantage or disadvantage? Evidence to date.Nat Sci Sleep. 2019; 11: 79-95https://doi.org/10.2147/nss.S169312
- Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy.Am J Manag Care. 2020; 26: S76-S84https://doi.org/10.37765/ajmc.2020.42769
- Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: Sleep Heart Health Study.Sleep. 2018; 41zsy047https://doi.org/10.1093/sleep/zsy047
- Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease.Sleep. 2022; 45zsac088https://doi.org/10.1093/sleep/zsac088
- Insomnia and risk of dementia in older adults: systematic review and meta-analysis.J Psychiatr Res. 2016; 77: 109-115https://doi.org/10.1016/j.jpsychires.2016.02.021
- Sleep problems and institutionalization of the elderly.Topics Geriatr. 1991; 4: 204-210https://doi.org/10.1177/089198879100400405
- The natural history of insomnia: a population-based 3-year longitudinal study.Arch Intern Med. 2009; 169: 447-453https://doi.org/10.1001/archinternmed.2008.610
- Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2017; 13: 307-349https://doi.org/10.5664/jcsm.6470
- Pharmacological treatment of insomnia.P T: Peer-Review J Formul Manag. 2015; 40: 759-771
- Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2017; 13: 307-349https://doi.org/10.5664/jcsm.6470
- Insomnia.JAMA. 2013; 309: 706-716https://doi.org/10.1001/jama.2013.193
- Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.BMC Fam Pract. 2012; 1340https://doi.org/10.1186/1471-2296-13-40
- Health economics of insomnia treatments: the return on investment for a good night's sleep.Sleep Med Rev. 2016; 30: 72-82https://doi.org/10.1016/j.smrv.2015.11.004
- Economic burden and managed care considerations for the treatment of insomnia.Am J Manag Care. 2020; 26 (PMID: 32282179): S91-S96https://doi.org/10.37765/ajmc.2020.43008
- Racial-ethnic differences in psychiatric diagnoses and treatment across 11 health care systems in the mental health research network.Psychiatr Serv. 2016; 67: 749-757
- Understanding racial disparities in cancer treatment and outcomes.J Am Coll Surg. 2010; 211: 105-113
- Disparities in lipid management for African Americans and Caucasians with coronary artery disease: a national cross-sectional study.BMC Cardiovasc Disord. 2004; 415https://doi.org/10.1186/1471-2261-4-15
- Pharmacotherapeutic disparities: racial, ethnic, and sex variations in medication treatment.Am J Health Syst Pharm. 2010; 67: 462-468https://doi.org/10.2146/ajhp090161
- Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Am J Public Health. 2015; 105: e60-e76
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.PLoS Med. 2007; 4e297
Regenstrief Institute. The Indiana Network for Patient Care. Available at: 〈https://www.regenstrief.org/rds/data/〉. Accessed August 1, 2021.
- Making neighborhood-disadvantage metrics accessible - the neighborhood Atlas.N Engl J Med. 2018; 378: 2456-2458https://doi.org/10.1056/NEJMp1802313
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27https://doi.org/10.1097/00005650-199801000-00004
- A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633https://doi.org/10.1097/MLR.0b013e31819432e5
- Insomnia in the elderly: a review.J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med. 2018; 14: 1017-1024https://doi.org/10.5664/jcsm.7172
- Disparities in quality of care among publicly insured adults with schizophrenia in four large US states, 2002–2008.Health Serv Res. 2014; 49: 1121-1144
- Geographic and clinical variation in clozapine use in the United States.Psychiatr Serv. 2014; 65: 186-192
- Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.Drug Alcohol Depend. 2018; 187: 29-34https://doi.org/10.1016/j.drugalcdep.2018.02.011
- Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.JAMA. 2008; 299: 70-78https://doi.org/10.1001/jama.2007.64
- Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain.Pain Med. 2015; 16: 633-640https://doi.org/10.1111/pme.12555
- Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States.Pain Med. 2012; 13: 150-174
- Racial-ethnic disparities in opioid prescriptions at emergency department visits for conditions commonly associated with prescription drug abuse.PLoS One. 2016; 11e0159224
- The influence of co-morbidities on prescribing pharmacotherapy for insomnia: evidence from US national outpatient data 1995-2004.J Med Econ. 2008; 11: 41-56https://doi.org/10.3111/13696990701817491
- Prevalence and factors associated with off-label antidepressant prescriptions for insomnia.Drug Healthc Patient Saf. 2011; 3: 27-36https://doi.org/10.2147/dhps.S21079
- The association between race and gender, treatment attitudes, and antidepressant treatment adherence.Int J Geriatr Psychiatry. 2014; 29: 169-177
- The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.Med Care. 2003; : 479-489
- Stigma and the acceptability of depression treatments among African Americans and whites.J Gen Intern Med. 2007; 22: 1292-1297
- Racial disparities in treatment engagement and outcomes in digital cognitive behavioral therapy for insomnia among pregnant women.Sleep Health. 2022; 0https://doi.org/10.1016/j.sleh.2022.10.010
- A systematic review of interventions to improve initiation of mental health care among racial-ethnic minority groups.Psychiatr Serv. 2018; 69: 628-647https://doi.org/10.1176/appi.ps.201700382
- Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial.Psychol Med. 2019; 49: 491-500https://doi.org/10.1017/S0033291718001113
- 0343 Does insomnia symptom severity vary by race/ethnicity.Sleep. 2019; 42: A140-A141https://doi.org/10.1093/sleep/zsz067.342
- DSM-5 Insomnia and short sleep: comorbidity landscape and racial disparities.Sleep. 2016; 39: 2101-2111https://doi.org/10.5665/sleep.6306
- Mistrust of health care organizations is associated with underutilization of health services.Health Serv Res. 2009; 44: 2093-2105https://doi.org/10.1111/j.1475-6773.2009.01017.x
- Racial and ethnic disparities in perceptions of physician style and trust.Arch Fam Med. 2000; 9: 1156-1163https://doi.org/10.1001/archfami.9.10.1156
- Sleep complaints in older adults: a racial comparison.J Gerontol: Ser A. 1995; 50A: M280-M284https://doi.org/10.1093/gerona/50A.5.M280
- Sleep in America: role of racial/ethnic differences.Sleep Med Rev. 2013; 17: 255-262https://doi.org/10.1016/j.smrv.2012.07.002
- Is primary care providers’ trust in socially marginalized patients affected by race?.J Gen Intern Med. 2011; 26: 846-851
- The effect of patient race and socio-economic status on physicians' perceptions of patients.Soc Sci Med. 2000; 50: 813-828
- Patient race/ethnicity and quality of patient-physician communication during medical visits.Am J Public Health. 2004; 94: 2084-2090https://doi.org/10.2105/ajph.94.12.2084
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.