Disparities in oral glucocorticoid prescribing among patients with mental disorders: nationwide cohort study

Glucocorticoids are widely prescribed for autoimmune and inflammatory conditions, but their long-term use carries serious risks. Patients with psychiatric disorders have a high burden of medical comorbidities, which may be associated with higher odds of receiving sustained glucocorticoid therapy.

We examined whether psychiatric patients were more likely to receive sustained oral glucocorticoid therapy compared with controls, and assessed variation across psychiatric subgroups.

This retrospective, nationwide cohort study used South Korea's National Health Insurance Service database. Adults diagnosed with a major psychiatric disorder in 2021 (n = 331 020) were compared with a sample without psychiatric disorders (n = 668 980). Propensity score matching generated 283 942 participants per group. The outcome was sustained oral glucocorticoid use in 2022, defined as ≥90 cumulative days with continuous therapy ≥90 days and prescription gaps ≤30 days.

Before propensity score matching, glucocorticoid use in 2022 was more frequent in psychiatric patients (13.8%) than controls (10.8%; odds ratio 1.32, 95% CI 1.31-1.34; P < 0.001). After matching, the difference persisted (14.7 v. 12.5%; odds ratio 1.18, 95% CI 1.16-1.19; P < 0.001). Multivariable analyses confirmed higher odds of glucocorticoid use (odds ratio 1.05, 95% CI 1.03-1.06; P < 0.001). Increased risk was observed for anxiety disorders (odds ratio 1.06) and obsessive-compulsive disorder (odds ratio 1.07), whereas major depressive disorder showed no significant association.

Psychiatric patients are more likely to receive sustained glucocorticoid therapy, underscoring the need for cautious prescribing and monitoring in this vulnerable population.