Black patients diagnosed with insomnia are half as likely to be prescribed an FDA-approved insomnia medication as white patients, according to findings reported in Sleep Health.
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The National Sleep Foundation released a position statement last year. Meanwhile, researchers reported findings showing that white patients with an insomnia diagnosis are more likely to be prescribed an FDA-approved drug than black patients.
The National Sleep Foundation, like many health care organizations, has placed a new emphasis on equity issues following the 2020 murder of George Floyd and as evidence that COVID-19 has had a disproportionate effect on black people. Early last year, the foundation released a position statement on equity in sleep health that outlined some of the underlying causes and offered strategies for bridging the gap year.
Some of the causes for the statement include racial discrimination and evidence that experiencing discrimination results in poor sleep health; financial distress and the fact that a higher percentage of people live in poverty and unemployment; the neighborhood environment and higher levels of pollution, noise, and other stressors in neighborhoods with a higher percentage of people from underserved groups; and access to health care and numerous studies that have shown that black people are less likely to be diagnosed with sleep-related conditions such as sleep apnea despite evidence that they are more likely to be affected by such a condition.
Changes suggested by the foundation to address some of the issues include developing culturally appropriate sleep resources; expand access to health care by facilitating population care and telemedicine; and expanding the addition of funding to existing efforts to address health care disparities to include sleep health elements.
Meanwhile, researchers continue to add to the evidence that disparities exist.
For example, Emma Holler, MPH, a PhD in epidemiology. candidate and graduate researcher at Indiana University, and her colleagues earlier this year reported findings on racial disparities in the pharmacological treatment of insomnia.
Using the electronic medical record from the Indiana Network for Patient Care, a health information exchange that includes seven health systems, they identified 12,326 patients who had a new diagnosis of insomnia, according to ICD coding. -9 and ICD-10, between 2011 and 2019. They narrowed this group down to 9,557 patients by excluding people who were prescribed insomnia medication before their diagnosis. Then they looked at how many of those patients were prescribed an FDA-approved insomnia drug, a group that includes but is not limited to Ambien (zolpidem), Belsomra (suvorexant), Butisol (butabarbital) and Sonata (zalepom).
Overall, only 12.4% (1,187 out of 9,557) of patients diagnosed with insomnia were prescribed an FDA-approved insomnia medication. But the percentage (6.2%) was even lower in black patients, Holler and colleagues reported, and it was a much lower percentage (13.5%) in white patients.
The differences narrowed when other medications commonly used to treat insomnia but not explicitly FDA-approved for this purpose were taken into account. These drugs include Doxepin, Trazodone, and Melatonin. The results show that 28.9% of black patients and 36.2% of white patients received prescriptions when a broader definition of prescription for insomnia was used.
“The results of this study suggest that there may be racial disparities in the pharmacological treatment of insomnia even when major sociodemographic factors are controlled and access to health care is guaranteed,” wrote Holler and colleagues. colleagues.
The results were reported in the sleep health in February.
