Racial Disparities in Mood Stabilizer Prescribing in Mania in Nonpsychotic, Hospitalized Patients With Bipolar I...

Objective: To investigate racial disparities in the first-time prescription of mood stabilizers for first-episode mania in nonpsychotic, hospitalized patients with bipolar I disorder, specifically comparing the rates of lithium and valproic acid prescription between non-Hispanic Black and non-Hispanic White patients.

Methods: A retrospective cohort study was conducted using the TriNetX database. We included eligible hospitalized non Hispanic Black and non-Hispanic White patients newly diagnosed with bipolar I disorder without psychotic features between January 1, 2014, and December 31, 2023. Propensity score matching was employed to create balanced comparison populations of non-Hispanic Black and non-Hispanic White patients, controlling for factors that may influence medication selection. A measure of association analysis was performed to calculate and compare the fraction of patients with either lithium or valproic acid use in both cohorts. Odds ratios were assessed.

Results: The study included 1,582 patients (N = 791 per cohort). After propensity matching, baseline characteristics were well balanced. Lithium was prescribed to 24% of White patients compared to 15% of Black patients (odds ratio [OR] 1.82, 95% CI, 1.41-2.35, P < .05). Conversely, valproic acid was prescribed to 20% of Black patients compared to 12% of White patients (OR 0.53 95% CI, 0.40-0.71, P < .05).

Conclusions: Significant disparities in the prescription rates of valproic acid and lithium were observed, with Black patients more likely to receive valproic acid and less likely to receive lithium compared to their White counterparts. Efforts to address these inequities should involve addressing structural, patient-related, and clinician-related factors that may contribute to our findings.