Ethnic inequalities in clozapine use among people with treatment-resistant schizophrenia: A retrospective cohort study using data from electronic clinical records

de Freitas, Daniela Fonseca, Patel, India, Kadra-Scalzo, Giouliana, Pritchard, Megan, Shetty, Hitesh, Broadbent, Matthew, Patel, Rashmi, Downs, Johnny, Segev, Aviv, Khondoker, Mizanur ORCID:, MacCabe, James H., Bhui, Kamaldeep and Hayes, Richard D. (2022) Ethnic inequalities in clozapine use among people with treatment-resistant schizophrenia: A retrospective cohort study using data from electronic clinical records. Social Psychiatry and Psychiatric Epidemiology, 57 (7). 1341–1355. ISSN 0933-7954

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Purpose: Clozapine is the most effective intervention for treatment-resistant schizophrenia (TRS). Several studies report ethnic disparities in clozapine treatment. However, few studies restrict analyses to TRS cohorts alone or address confounding by benign ethnic neutropenia. This study investigates ethnic equity in access to clozapine treatment for people with treatment-resistant schizophrenia spectrum disorder. Methods: A retrospective cohort study, using information from 11 years of clinical records (2007–2017) from the South London and Maudsley NHS Trust. We identified a cohort of service-users with TRS using a validated algorithm. We investigated associations between ethnicity and clozapine treatment, adjusting for sociodemographic factors, psychiatric multi-morbidity, substance misuse, neutropenia, and service-use. Results: Among 2239 cases of TRS, Black service-users were less likely to be receive clozapine compared with White British service-users after adjusting for confounders (Black African aOR = 0.49, 95% CI [0.33, 0.74], p = 0.001; Black Caribbean aOR = 0.64, 95% CI [0.43, 0.93], p = 0.019; Black British aOR = 0.61, 95% CI [0.41, 0.91], p = 0.016). It was additionally observed that neutropenia was not related to treatment with clozapine. Also, a detention under the Mental Health Act was negatively associated clozapine receipt, suggesting people with TRS who were detained are less likely to be treated with clozapine. Conclusion: Black service-users with TRS were less likely to receive clozapine than White British service-users. Considering the protective effect of treatment with clozapine, these inequities may place Black service-users at higher risk for hospital admissions and mortality.

Item Type: Article
Additional Information: Funding: 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. RP received support from a NIHR Advanced Fellowship (NIHR301690), 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 the NIHR Clinician Science Fellowship award (CS-2018–18-ST2-014), received support from a MRC Clinical Research Training Fellowship (MR/L017105/1) and a Psychiatry Research Trust Peggy Pollak Research Fellowship in Developmental Psychiatry. The views expressed are those of the authors and not those of the funding organisations mentioned.
Uncontrolled Keywords: asian british,benign ethnic neutropenia,black british,clozapine,health inequalities,refractory psychosis,epidemiology,health(social science),social psychology,psychiatry and mental health ,/dk/atira/pure/subjectarea/asjc/2700/2713
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 07 Mar 2022 15:30
Last Modified: 23 Oct 2022 03:37
DOI: 10.1007/s00127-022-02257-3

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