Pharmacoepidemiology of antipsychotic utilization among children and adolescents in Montevideo between 2018 and 2022

Abstract

Background: The prescription of antipsychotics in the pediatric population has increased worldwide, especially of second generation antipsychotics. Prescription patterns are not homogeneous across populations. Studies demonstrate differences according to sex, age and socioeconomic level. In Uruguay, the available evidence is limited and comes from small, single-center studies and does not provide information on changes over time. Purpose:describe the use of antipsychotics in 1- to 19-year-old children and adolescents in Montevideo between 2018 and 2022, considering differences according to socioeconomic level. Study design: A descriptive observational study of medication use was conducted. Methods: It included children and adolescent users of antipsychotics treated in eight healthcare centers in Montevideo (one public, five collective healthcare institutions, and two private insurance schemes), which together provide coverage to approximately 230,000 children and adolescents in total. Pharmacy dispensing data were analyzed between 1/1/2018 and 12/31/2022. The primary endpoint was the defined daily dose (DDD) per 1,000 inhabitants/day (DDD per 1,000 inhabitants/day), calculated globally and by drug. Temporal variation was evaluated in three periods: pre-pandemic (2018–2019), start of the pandemic (2020) and post-pandemic (2021–2022). Descriptive statistics were used. Findings: The average DDD per 1,000 inhabitants/day in the period was 11.4, with a predominance of risperidone and aripiprazole. The highest utilization was observed among adolescents aged 15–19 years, followed by the group aged 5–14 years, and was higher in males. Although the use of antipsychotics increased over time in all socioeconomic levels, it was higher for providers of care at the low socioeconomic level and lower for providers of care at the high socioeconomic level. Conclusion: This is the first study in Uruguay that describes the use of antipsychotic agents in children and adolescents by socioeconomic level; it showed a steady increase in their use.