Schizophrenia Diagnosis Disparities

For years, nursing homes have misused antipsychotics to subdue residents with Alzheimer’s and dementia-related diseases. In 2012, the Centers for Medicare & Medicaid Services partnered with nursing homes across the United States to launch the National Partnership to Improve Dementia Care in Nursing Homes to address medication misuse. The partnership requires nursing homes to report the number of residents on antipsychotics to the government, but no report is necessary if there is a schizophrenia diagnosis behind the antipsychotic prescription. The new policies did not consider how this caveat would create an unintentional consequence of new schizophrenia diagnoses among nursing home patients with co-occurring dementia, particularly among residents of color.

Prior research indicates older Black adults are more likely to be diagnosed with schizophrenia compared to their White counterparts. This paired with the well-documented racial disparities in nursing home quality caused Shekinah A. Fashaw-Walters to ask whether schizophrenia diagnoses increased disproportionately among Black residents with dementia following the new policy. She and her research team analyzed nursing home resident data from 2011-2015 to see if race influenced schizophrenia diagnoses before and after the partnership.

Using a statistical model accounting for residents’ demographics, daily function, and end-of-life status, they found an increase in schizophrenia diagnoses only among Black nursing home residents with Alzheimer’s or dementia. The dotted pink line in the figure shows the increase of schizophrenia diagnoses among Black residents with Alzheimer’s disease from pre- to post-partnership. Conversely, the dotted green line shows a decrease in schizophrenia diagnoses among residents of other races with the same neurodegenerative condition.

The alarming rise of schizophrenia diagnoses may be perpetuating the antipsychotic misuse the partnership was originally aiming to fix. The diagnosis disparity felt by Black residents highlights what can happen when the effects of structural racism are not considered in policy planning.

Databyte via Shekinah A. Fashaw-Walters, Ellen McCreedy, Julie P. W. Bynum, Kali S. Thomas, Theresa I. Shireman. Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD. Journal of the American Geriatrics Society, 2021.