TY - JOUR
T1 - Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register
AU - Wellesley Wesley, Emma
AU - Patel, India
AU - Kadra-Scalzo, Giouliana
AU - Pritchard, Megan
AU - Sheety, Hitesh
AU - Broadbent, Matthew
AU - Segev, Aviv
AU - Patel, Rashmi
AU - Downs, Johnny
AU - Maccabe, James
AU - Hayes, Richard
AU - Fonseca de Freitas, Daniela
N1 - Funding Information:
This work utilised the Clinical Record Interactive Search (CRIS) platform funded and developed by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London Guy's and St Thomas' Charity. RP has received support from a Medical Research Council (MRC) Health Data Research UK Fellowship ( MR/S003118/1 ) and a Starter Grant for Clinical Lecturers (SGL015/1020) supported by the Academy of Medical Sciences , The Wellcome Trust , MRC , British Heart Foundation , Arthritis Research UK , the Royal College of Physicians and Diabetes UK . JD is supported by NIHR Clinician Science Fellowship award ( CS-2018-18-ST2-014 ) and has received support from a Medical Research Council (MRC) Clinical Research Training Fellowship ( MR/L017105/1 ) and Psychiatry Research Trust Peggy Pollak Research Fellowship in Developmental Psychiatry. GKS, MP, HS, MB, JHM, RDH and DFdF receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . The views expressed are those of the authors and not necessarily those of the mentioned funding organisations.
Funding Information:
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.
Publisher Copyright:
© 2021 The Authors
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
KW - healthcare inequality, sex, refractory psychosis, psychopharmacology
UR - http://www.scopus.com/inward/record.url?scp=85108742139&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2021.05.006
DO - 10.1016/j.schres.2021.05.006
M3 - Article
SN - 0920-9964
VL - 232
SP - 68
EP - 76
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -
