Objective: Patients with schizophrenia experience risks for metabolic dysregulation from medications and lifestyle behaviors. Although most patients with schizophrenia in the Veterans Health Administration (VA) receive antipsychotics, variation in monitoring metabolic dysregulation by race/ethnicity has not been assessed. This study analyzed differential monitoring of metabolic parameters by minority status.
Methods: This retrospective study approximated the five components of metabolic syndrome (fasting glucose, high-density-lipoprotein cholesterol, triglycerides, blood pressure, and large waistline) using archival data, substituting body mass index for waistline. VA patients with schizophrenia age 50 or older were followed from October 1, 2001 through September 2009 (N = 30,258). Covariates included age, gender, race (white, black), Hispanic ethnicity, region, marital status, VA priority status, comorbidity, and antipsychotic type. Repeated-measures analysis assessed the association of race/ethnicity with metabolic monitoring.
Results: Average patients age was 59 years (standard deviation: 9; range: 50-101), 97% were men, 70% white, 30% black, and 8% Hispanic. At baseline, 6% were monitored on all five metabolic components; this increased to 29% by 2005. In adjusted models, blacks were less likely to be monitored on all parameters, whereas Hispanics were less likely to have glucose and high-density-lipoprotein cholesterol monitored but more likely to have triglycerides tested. By 2009, lab assays were similar across race and ethnicity.
Conclusion: Guideline-concordant monitoring metabolic parameters appear to be equitable but low and somewhat at odds with racial/ethnic risk among older patients with schizophrenia. Physicians should discuss lipids, weight, and glucose with patients at risk for developing heart disease, diabetes, and other sequelae of the metabolic syndrome.
Keywords: African Americans; Hispanic; healthcare quality assessment; metabolic syndrome; schizophrenia; veterans.
Published by Elsevier Inc.