Background
Methods
Population
Definition of SGA initiation
Covariates
Demographics
Clinical course variables
Comorbidities
Establishing time-varying covariates
Data analyses
Results
Overall SGA use for bipolar disorder
SGA initiation in bipolar disorder
Description of the patient sample and bivariate comparisons
Bipolar population (N =170,713) a
| Never initiated SGA during study period (N =81,167, 64.1% of those eligible for SGA initiation) | Ever initiated SGA during study period (N =45,389, 35.9% of those eligible for SGA initiation) | ||||
---|---|---|---|---|---|---|
Variable | Mean | SD | Mean | SD | Mean | SD |
Age at study entry
b
| 50.3 | 13.3 | 51.6 | 13.6 | 48.3 | 13.0 |
N
|
%
|
N
|
%
|
N
|
%
| |
Gender (female)
| 24,076 | 14.1 | 10,804 | 13.3 | 6,954 | 15.3 |
Disability status ≥50%
c,d
| 52,584 | 30.9 | 23,067 | 28.5 | 13,148 | 29.0 |
Marital status
d
| 76,315 | 44.9 | 34,786 | 43.3 | 18,265 | 40.5 |
Race/ethnicity
e
| ||||||
White | 127,742 | 82.2 | 60,381 | 83.0 | 34,425 | 82.6 |
African American | 20,884 | 13.4 | 9,305 | 12.8 | 5,588 | 13.4 |
Hispanic | 4,034 | 2.6 | 1,861 | 2.6 | 891 | 2.1 |
Other race/ethnicityc
| 2,684 | 1.7 | 700 | 1.0 | 455 | 1.1 |
Clinical/treatment course
d
| ||||||
Psychotic features | 22,119 | 13.0 | 6,822 | 8.4 | 7,322 | 16.1 |
Bipolar type I (versus type II/NOS)f
| 145,128 | 85.0 | 68,344 | 84.2 | 40,283 | 88.8 |
Antidepressant prescription | 139,807 | 81.9 | 55,920 | 68.9 | 34,969 | 77.0 |
Antimanic prescription | 128,596 | 75.3 | 51,820 | 63.8 | 35,755 | 78.8 |
Any psychiatric hospitalization | 64,117 | 37.6 | 23,284 | 28.7 | 21,330 | 47.0 |
Comorbidities
d
| ||||||
Diabetes | 42,517 | 24.9 | 20,679 | 25.5 | 10,138 | 22.3 |
Obesity | 61,182 | 35.8 | 27,469 | 33.8 | 16,581 | 36.5 |
Hyperlipidemia | 101,886 | 59.7 | 47,770 | 58.9 | 26,190 | 57.7 |
Substance abuse | 79,658 | 46.7 | 33,202 | 40.9 | 23,280 | 51.3 |
Tobacco use disorder | 86,311 | 50.6 | 37,406 | 46.1 | 24,182 | 53.3 |
Anxiety disorder | 102,130 | 59.8 | 43,310 | 53.4 | 27,331 | 60.2 |
Sleep disorder | 29,355 | 17.2 | 11,762 | 14.5 | 8,072 | 17.8 |
Cardiac dysrhythmia | 19,600 | 11.5 | 9,509 | 11.7 | 4,827 | 10.6 |
Liver disorder | 22,332 | 13.1 | 9,460 | 11.7 | 5,997 | 13.2 |
Kidney disorder | 19,044 | 11.2 | 9,271 | 11.4 | 4,729 | 10.4 |
Thyroid disorderc
| 20,226 | 11.9 | 9,429 | 11.6 | 5,566 | 12.3 |
Traumatic brain injury | 9,209 | 5.4 | 3,629 | 4.5 | 2,557 | 5.6 |
Month-by-month, multivariate correlates of SGA initiation
Variable | Odds ratio | 95% CI – lower | 95% CI – upper |
p
|
---|---|---|---|---|
Age (decade)
| 0.997 | 0.997 | 0.997 | <.0001 |
Gender (female)
| 0.846 | 0.815 | 0.878 | <.0001 |
≥ 50% disability status
| 0.740 | 0.717 | 0.763 | <.0001 |
Marital status (married)
| 1.011 | 0.985 | 1.039 | .4062 |
Race/ethnicity
a
| ||||
African American | 1.068 | 1.024 | 1.114 | .0021 |
Hispanic | 0.989 | 0.901 | 1.087 | .8222 |
Other race/ethnicity | 1.096 | 0.964 | 1.246 | .1614 |
Region
b
| ||||
Midwest | 0.991 | 0.955 | 1.028 | .6221 |
South | 1.288 | 1.245 | 1.332 | <.0001 |
West | 0.919 | 0.886 | 0.953 | <.0001 |
Clinical/treatment factors in prior year
| ||||
Psychotic features | 1.696 | 1.520 | 1.891 | <.0001 |
Bipolar type I (versus type II/NOS)c
| 0.968 | 0.935 | 1.003 | .0736 |
Antidepressant prescription | 0.903 | 0.882 | 0.924 | <.0001 |
Antimanic prescription | 0.620 | 0.606 | 0.634 | <.0001 |
Comorbidities in prior year
| ||||
Diabetes | 0.919 | 0.882 | 0.957 | <.0001 |
Obesity | 0.958 | 0.913 | 1.004 | .0739 |
Hyperlipidemia | 0.991 | 0.960 | 1.023 | .5860 |
Substance abuse | 0.965 | 0.933 | 0.999 | .0407 |
Tobacco use disorder | 1.065 | 1.030 | 1.103 | .0003 |
Anxiety disorder | 1.082 | 1.051 | 1.114 | <.0001 |
Sleep disorder | 1.555 | 1.435 | 1.685 | <.0001 |
Cardiac dysrhythmia | 1.096 | 0.999 | 1.202 | .0520 |
Liver disorder | 1.145 | 1.079 | 1.214 | <.0001 |
Kidney disorder | 1.187 | 1.069 | 1.318 | .0014 |
Thyroid disorder | 1.021 | 0.956 | 1.089 | .5372 |
Traumatic brain injury | 1.109 | 0.944 | 1.303 | .2068 |
Change per year
| 0.988 | 0.982 | 0.993 | <.0001 |
The role of clinical complexity in SGA initiation rates over time
Association of comorbidities with specific SGAs
Olanzapine | Quetiapine | Risperidone | Ziprasidone | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Comorbidity in the past year | Odds ratio | CI – lower | CI – upper |
p -value | Odds ratio | CI – lower | CI – upper |
p -value | Odds ratio | CI – lower | CI – upper |
p -value | Odds ratio | CI – lower | CI – upper |
p -value |
Diabetes | 0.477 | 0.428 | 0.531 | <.0001 | 0.771 | 0.718 | 0.828 | <.0001 | 0.856 | 0.789 | 0.929 | .0002 | 1.05 | 0.939 | 1.174 | .3945 |
Obesity | 0.352 | 0.305 | 0.407 | <.0001 | 0.657 | 0.602 | 0.716 | <.0001 | 0.607 | 0.547 | 0.675 | <.0001 | 1.109 | 0.974 | 1.262 | .1181 |
Hyperlipidemia | 0.686 | 0.632 | 0.744 | <.0001 | 0.857 | 0.808 | 0.91 | <.0001 | 0.838 | 0.781 | 0.898 | <.0001 | 0.944 | 0.855 | 1.041 | .2469 |
Substance abuse | 1.321 | 1.23 | 1.417 | <.0001 | 1.363 | 1.288 | 1.442 | <.0001 | 1.216 | 1.14 | 1.298 | <.0001 | 0.987 | 0.896 | 1.088 | .7917 |
Sleep disorder | 0.860 | 0.695 | 1.065 | .1666 | 1.158 | 0.991 | 1.353 | .0655 | 0.794 | 0.654 | 0.965 | .0204 | 1.05 | 0.809 | 1.362 | .7140 |
Cardiac dysrhythmia | 1.422 | 1.137 | 1.778 | .0020 | 0.971 | 0.800 | 1.179 | .7690 | 1.116 | 0.9 | 1.385 | .3166 | 0.725 | 0.505 | 1.042 | .0825 |