Racial Disparities in Older Adults with Schizophrenia: Demographic, Clinical, and Social/Psychosocial Factors

• Published in: The American journal of geriatric psychiatry 2024-04, Vol.32 (4), p.S57-S58
• Main Authors: Afzal, Moazam, Lu, James, Cohen, Carl I
• Format: Article
• Language: English
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2024.01.131

African Americans (AA) are 2.5 times more likely than Caucasians (C) to be diagnosed with schizophrenia. In younger schizophrenia samples, significant racial differences have been found in discrimination, employment, educational attainment, residential status, number of children, income, marriage, social support, religiosity, treatment status, pharmacotherapy, quality of life, and PANSS scores. Despite the importance of the association of race with a variety of disparities in clinical and social outcomes, no comprehensive studies have been conducted examining racial differences in older adults with schizophrenia (OAS). We aimed to determine to what extent racial differences persist among persons with long-standing schizophrenia. The sample comprised 221 persons in NYC (C:62%, AA:38%) aged 55 and older living in the community (mean age: 61 years) who had developed schizophrenia spectrum disorder before age 45 (mean age of onset: 31 years). The sample was stratified to capture persons living in various residential settings; 12%, 28%, and 60% were living with family, independently, or in supported housing, respectively. All were receiving some clinical care. Persons with substantial cognitive impairment were excluded. Based on previous studies of racial differences in younger schizophrenia populations, we conceptualized three broad categories: demographic, clinical, and social/psychosocial. We administered instruments that generated variables within the three categories: The Positive and Negative Syndrome Scale (PANSS), Center for Epidemiologic Studies-Depression Scale, Community Integration Scale, Quality of Life Index, Lifetime Traumatic Stress, Religiosity, Instrumental Activities of Daily Living, Ethnic Identity, Network Analysis Profile, Coping, Conflict Tactics, Financial Strain, Service Usage, and additional items about the characteristics of hallucinations and delusions. Initial bivariate analysis identified 11 significant variables that distinguished between the racial groups, and these were entered with 3 demographic covariates into a binary logistic regression analysis with race as the dependent variable. AAs were significantly more likely to live with family (OR=6.4), have children (OR=1.3), feel discriminated against (OR=1.3), and have a higher PANSS positive symptom score (OR=1.1), but less likely to report having a quick temper (OR=0.2). Among AAs living with family, 80% lived with children. A post-hoc regression analysis indicated that race (A