Prescriptions for benzodiazepines vary by race, income
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Key takeaways:
- White race was associated with greater likelihood of being prescribed benzodiazepines by their primary care physician.
- Non-white lower-income patients were least likely to receive a prescription.
SAN FRANCISCO — Patients from underrepresented populations were less likely than white patients to be prescribed benzodiazepines by a primary care physician, with disparities persisting regardless of income, according to a poster presented here.
The poster was presented by Samyukta Dore, BA, an MD/MPH dual degree candidate at Cleveland Clinic Lerner College of Medicine, at the American Psychiatric Association annual meeting.
“Prior research examining opioid prescriptions, another commonly used medication with dependency concerns, showed that white patients were more likely than Black patients to be prescribed opioids, and that lower-income white patients were more likely than higher-income white patients to receive opioid prescriptions,” Dore told Healio. “Motivated by this research, we wanted to examine the relationship between race and economic status on benzodiazepine prescribing in a primary care sample.”
Dore and colleagues analyzed data from an established retrospective cohort of adult primary care patients in a large Midwestern health care system who attended at least one visit from 2019 to 2020. Specifically, they assessed associations between information reported on electronic medical records — such as race, median income by ZIP code, insurance and other sociodemographics — and receipt of benzodiazepine prescriptions.
White patients were most likely to receive an initial benzodiazepine prescription (6.5%) compared with African American patients (2.7%; P < .001), Asian American patients (2%; P < .001) and patients with a multicultural/multiracial background (3.8%; P < .001). White patients were also more likely to receive a recurrent prescription (1.2%) compared with patients of other races (0.5%, 0.2% and 0.7%, respectively; all P < .001).
Analyses revealed significant associations between benzodiazepine prescription and median income by ZIP code (P < .001), insurance (P < .001), sex (P = .014) and diagnosis of generalized anxiety disorder (P < .001), insomnia (P = .019) and panic disorder (P < .001), according to the poster.
Notably, analyses of the association between prescription and income indicated that racial disparities persisted, the researchers reported. For example, median income by ZIP code had the weakest association with benzodiazepine prescription in Asian American patients and the strongest association in African American patients.
“While we did expect racial identity to affect patterns of benzodiazepine prescription, it was surprising to find that income did not mitigate the effects of race on benzodiazepine prescription,” Dore told Healio. “Given the addictive potential of benzodiazepines, lower rates of benzodiazepine prescription may be protective against benzodiazepine use disorder in racial minority patients and lower-income patients. However, these findings suggest a racial and economic bias in our health care system that may result in under-prescribing of benzodiazepines and inadequate treatment of underlying conditions in these populations.”
Future studies should investigate the root of these disparities and seek to establish interventions to mitigate their impact, Dore said.