Pharmacoepidemiology
Disparities in Potentially Inappropriate Central Nervous System Medication Prescribing Among Sexual and Gender Minority Adults Chelsea Wong* Chelsea Wong Robert Cavanaugh Louisa H Smith Dae H Kim Carl G. Streed, Jr. Farzana Kapadia Brianne Olivieri-Mui
Central nervous system (CNS) medications: antidepressants, antipsychotics, hypnotic/sedatives, and anxiolytics; are used to treat mental health conditions but carry risks when used inappropriately. Sexual and gender minority (SGM) older adults face unique healthcare disparities, which may include differences in prescribing patterns and healthcare utilization. This study aimed to 1) assess the prevalence of inappropriate CNS medication prescriptions by SGM status and 2) evaluate whether SGM status moderates the association between prescribing and healthcare utilization.
Using All of Us electronic health record data, we included participants ≥50yo with no appropriate diagnosis for use of each of four CNS medication classes. A 1:5 SGM:non-SGM matched sample was created for each class to account for frailty, age, race & ethnicity, income, marital status, general mental health, and HIV status. Logistic regression assessed differences in inappropriate CNS prescriptions by SGM status, and negative binomial regression with offset evaluated whether SGM status moderated the association between CNS prescriptions and emergency department (ED) visits over 1 year.
The full sample included 6070 SGM and 118,498 non-SGM adults with matched samples ranging from 28,806-35,574 participants. SGM adults were more likely to have an inappropriate prescription for antidepressants (Odds Ratio [OR], 95% Confidence Interval: 1.15 [1.00,1.31]), antipsychotics (OR: 1.32 [1.10,1.59]), and hypnotic/sedatives (OR: 1.25 [1.09,1.43]). Inappropriate prescriptions across all four classes were associated with higher ED visits: antidepressants (Rate Ratio [RR]: 2.44 [1.84,3.25]), antipsychotics (RR: 3.33 [2.34,4.74]), hypnotic/sedatives (RR: 1.57 [1.18,2.10]), anxiolytics (RR: 2.22 [1.57,3.14]). SGM status was not modify these associations.
Our findings highlight disparities in prescribing patterns by SGM status among older adults and underscore the need for careful medication review among this population