Distribution and correlates of long-acting injectable antipsychotic use among community mental health center patients

• Black patients were twice as likely to use long-acting injectable antipsychotics. • Rural patients were least likely to use long-acting injectable antipsychotics. • Older adults were less likely to use long-acting injectable antipsychotics. • Race was unrelated to use of oral antipsychotic medications. • Black patients were more likely to use first-generation medications. Although long-acting injectable antipsychotics (LAIs) are an important pharmaceutical option in the management of schizophrenia and related disorders, little is known about patient characteristics related to LAI use in real-world outpatient settings. We analyzed electronic medical records from 41,401 patients who received psychiatric services from one of 16 regional mental health centers operated by the South Carolina Department of Mental Health in 2022. We compared the use of first- and second-generation LAIs and oral antipsychotics by sociodemographic (age, gender, race/ethnicity, zip code, payment source) and clinical characteristics (psychiatric diagnoses, service use). We used logistic regression models to estimate associations between patient characteristics and the likelihood of using LAIs. In total, 7,029 (17.0 %) patients used LAIs in 2022, including 5,901 with schizophrenia or another psychotic disorder. Compared to White patients, Black (Odds Ratio (OR): 2.19, 95 % Confidence Interval (CI): 1.96 – 2.44) and Asian (OR: 3.39, 95 % CI: 1.54 – 7.43) patients were significantly more likely to use LAIs, controlling for other patient demographic and clinical characteristics. LAI users were also more likely to be male (OR: 1.83, 95 % CI: 1.64, 2.03), to live in suburban areas (OR: 1.25, 95 % CI: 1.10, 1.42), and to use Medicaid (OR: 1.55, 95 % CI: 1.34, 1.79). Similar differences were not found for oral antipsychotics. Results suggest that LAI use differs substantially by patient characteristics independent of psychiatric diagnoses. Identifying and understanding reasons for differences in LAI use is important to promote equitable access to and use of LAIs across racial, geographic, and other sociodemographic groups.