ABSTRACT Objective This study sought to assess the demographic factors that alter the likelihood of being prescribed clozapine. The primary hypothesis is that African American patients are less likely to be prescribed Clozapine than White and other racial groups. Additionally, this study aims to expand on earlier studies of clozapine by examining how multiple variables, especially social determinants of health, gender, rurality, and care patterns affect the rates at which clozapine is prescribed. Methods This observational study examines the racial disparities and other factors associated with receiving a clozapine prescription for patients with a schizophrenia diagnosis using structured data in the Electronic Health Records (EHR) from a multi-facility health system from 10/1/2015 - 11/30/2021. Bivariate analysis, multiple logistic regression, and sensitivity analysis tests were performed to determine which factors differed significantly between the group of patients who were prescribed clozapine and those who were not. Results Results showed that being white and having a higher socioeconomic income was associated with an increased clozapine prescription rate, while gender, rurality, age at first diagnosis, and ethnicity did not influence prescription likelihood. Increased treatment length was also associated with a greater likelihood of being prescribed clozapine. Conclusion African American patients are over-diagnosed with schizophrenia and under-prescribed clozapine compared to Caucasians after controlling for the variables associated with demographics, social determinants of health, and care access patterns. Future research is needed to understand and disentangle the biological, clinical, administrative, and societal causes behind the disparity in clozapine treatment.

The authors have declared no competing interest.

The work was supported by a 2021 grant from the Foundation of Hope.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The University of North Carolina at Chapel Hill Institutional Review Board. The study was reviewed and approved by the UNC-CH Institutional Review Board (IRB # 21-1654).

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All data produced in the present study are available upon reasonable request to the authors