Roger S McIntyre1,2,3,4, Vincent Chin-Hung Chen5,6, Yena Lee1, Leanna M W Lui1, Amna Majeed1, Mehala Subramaniapillai1, Rodrigo B Mansur1, Joshua D Rosenblat1, Yao-Hsu Yang7,8,9, Yi-Lung Chen10,11. 1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada. 2. Department of Psychiatry, University of Toronto, Toronto, Canada. 3. Department of Pharmacology, University of Toronto, Toronto, Canada. 4. Brain and Cognition Discovery Foundation, Toronto, Canada. 5. Department of Psychiatry, School of Medicine, Chang Gung University, Taoyuan, Taiwan. 6. Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan. 7. School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 8. Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan. 9. Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan. 10. Department of Healthcare Administration, Asia University, No. 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan. elong@asia.edu.tw. 11. Department of Psychology, Asia University, Taichung, Taiwan. elong@asia.edu.tw.
Abstract
PURPOSE: Benzodiazepines are commonly prescribed globally. We hypothesize that gender stereotypes influence benzodiazepine prescriptions insofar as male prescribers are more likely to prescribe benzodiazepines to female patients. METHODS: Our nationwide cohort study included 2,127,441 patients with a psychiatric disorder (ICD-9 codes 290-319) and 38,932 prescribers as part of the Taiwan National Health Insurance Research Database (1997-2013). We evaluated the effects of patient and prescriber gender on the proportion of patients prescribed benzodiazepines and the cumulative dosage of benzodiazepine prescription (mg) using generalized estimating equation and general linear models. RESULTS: The proportion of patients prescribed benzodiazepines was higher among male (vs. female) prescribers [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05-1.07] and among female (vs. male) patients (OR = 1.08, 95% CI = 1.08-1.09). Similarly, male prescriber gender (β = 10,292.2, SE = 1265.5, p < 0.001) and female patient gender (β = 7913.7, SE = 627.1, p < 0.001) predicted higher cumulative dosages of benzodiazepine prescription. Mean cumulative dosage was highest among female patients seen by male prescribers (β = 4283.7, SE = 717.6, p < 0.001). The results were consistent in sensitivity analyses of patients with anxiety disorder (n = 1,632,363), major depression (n = 1,122,796), or chronic administration (n = 1,981,819), and prescribers with psychiatrists (n = 1276), and non-psychiatrists (n = 33,268). CONCLUSIONS: Male prescribers were more likely to prescribe benzodiazepines to female patients relative to male patients. This gender bias in prescription is significant and warrants careful attention at point of care. We hypothesize that internalized societal biases and stereotypes affect benzodiazepine prescribing behaviour.
PURPOSE:Benzodiazepines are commonly prescribed globally. We hypothesize that gender stereotypes influence benzodiazepine prescriptions insofar as male prescribers are more likely to prescribe benzodiazepines to female patients. METHODS: Our nationwide cohort study included 2,127,441 patients with a psychiatric disorder (ICD-9 codes 290-319) and 38,932 prescribers as part of the Taiwan National Health Insurance Research Database (1997-2013). We evaluated the effects of patient and prescriber gender on the proportion of patients prescribed benzodiazepines and the cumulative dosage of benzodiazepine prescription (mg) using generalized estimating equation and general linear models. RESULTS: The proportion of patients prescribed benzodiazepines was higher among male (vs. female) prescribers [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05-1.07] and among female (vs. male) patients (OR = 1.08, 95% CI = 1.08-1.09). Similarly, male prescriber gender (β = 10,292.2, SE = 1265.5, p < 0.001) and female patient gender (β = 7913.7, SE = 627.1, p < 0.001) predicted higher cumulative dosages of benzodiazepine prescription. Mean cumulative dosage was highest among female patients seen by male prescribers (β = 4283.7, SE = 717.6, p < 0.001). The results were consistent in sensitivity analyses of patients with anxiety disorder (n = 1,632,363), major depression (n = 1,122,796), or chronic administration (n = 1,981,819), and prescribers with psychiatrists (n = 1276), and non-psychiatrists (n = 33,268). CONCLUSIONS: Male prescribers were more likely to prescribe benzodiazepines to female patients relative to male patients. This gender bias in prescription is significant and warrants careful attention at point of care. We hypothesize that internalized societal biases and stereotypes affect benzodiazepine prescribing behaviour.
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