Unraveling ethnic disparities in antipsychotic prescribing among patients with psychosis: a retrospective cohort study based on electronic clinical records

Tao Wang, David Codling, Dinesh Bhugra, Yamiko Msosa, Matthew Broadbent, Rashmi Patel, Angus Roberts, Philip McGuire, Robert Stewart, Richard Dobson, Robert Harland

Research output: Contribution to journalArticlepeer-review


Background: Previous studies have shown mixed evidence on ethnic dis-
parities in antipsychotic prescribing among patients with psychosis in the
UK, partly due to small sample sizes. This study aimed to examine the
current state of antipsychotic prescription with respect to patient ethnicity
among the entire population known to a large UK mental health trust with
non-affective psychosis, adjusting for multiple potential risk factors.
Methods: This retrospective cohort study included all patients (N = 19, 291)
who were aged 18 years or over at their first diagnoses of non-affective psy-
chosis (identified with the ICD-10 codes of F20-F29) recorded in electronic
health records (EHRs) at the South London and Maudsley NHS Trust until
March 2021. The most recently recorded antipsychotic treatments and pa-
tient attributes were extracted from EHRs, including both structured fields
and free-text fields processed using natural language processing applications.
Multivariable logistic regression models were used to calculate the odds ratios
(OR) for antipsychotic prescription according to patient ethnicity, adjusted
for multiple potential contributing factors, including demographic (age and
gender), clinical (diagnoses, duration of illness, service use and history of
cannabis use), socioeconomic factors (level of deprivation and own-group
ethnic density in the area of residence) and temporal changes in clinical
guidelines (date of prescription).
Results: The cohort consisted of 43.10% White, 8.31% Asian, 40.80% Black,
2.64% Mixed, and 5.14% of patients from Other ethnicity. Among them,
92.62% had recorded antipsychotic receipt, where 24.05% for depot antipsy-
chotics and 81.72% for second-generation antipsychotic (SGA) medications.
Most ethnic minority groups were not significantly different from White pa-
tients in receiving any antipsychotic. Among those receiving antipsychotic
prescribing, Black patients were more likely to be prescribed depot (adjusted
OR 1.29, 95% confidence interval (CI) 1.14-1.47), but less likely to receive
SGA (adjusted OR 0.85, 95% CI 0.74-0.97), olanzapine (OR 0.82, 95% CI
0.73-0.92) and clozapine (adjusted OR 0.71, 95% CI 0.6-0.85) than White
patients. All the ethnic minority groups were less likely to be prescribed
olanzapine than the White group.
Conclusions: Black patients with psychosis had a distinct pattern in an-
tipsychotic prescription, with less use of SGA, including olanzapine and cloza-
pine, but more use of depot antipsychotics, even when adjusting for the ef-
fects of multiple demographic, clinical and socioeconomic factors. Further
research is required to understand the sources of these ethnic disparities and
eliminate care inequalities.
Original languageEnglish
Pages (from-to)168-179
Number of pages12
JournalSchizophrenia Research
Early online date3 Sept 2023
Publication statusPublished - Oct 2023


  • Healthcare inequalit
  • Ethnicity
  • Psychosis
  • Antipsychotic prescription
  • Electronic health records
  • Psychopharmacology


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