Influence of Socioeconomic Status on Antipsychotic Prescriptions among Youth in France

Olivier Bonnot (1, 2) , Mélanie Dufresne , Paula Herrera (3) , Emmanuelle Michaud , Jacques Pivette , Anicet Chaslerie , Anne Sauvaget , Caroline Victorri-Vigneau (4)

1 LPPL - Laboratoire de Psychologie des Pays de la Loire
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes
3 DRSM Normandie - Direction Régionale du Service Médical de Normandie
4 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch

Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. Method Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013–June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject’s socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). Results There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X 2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). Conclusions Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners.

Domaines: Sciences du Vivant [q-bio]

Olivier Bonnot, Mélanie Dufresne, Paula Herrera, Emmanuelle Michaud, Jacques Pivette, et al.. Influence of Socioeconomic Status on Antipsychotic Prescriptions among Youth in France. BMC Psychiatry, 2017, 17 (1), pp.82. ⟨10.1186/s12888-017-1232-3⟩. ⟨hal-03158122⟩