Racial disparities in the pharmacological treatment of insomnia: A time-to-event analysis using real-world data

Sleep Health. 2023 Apr;9(2):128-135. doi: 10.1016/j.sleh.2023.02.002. Epub 2023 Feb 27.


Objective: Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort.

Methods: Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis.

Results: In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications.

Conclusions: Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.

Keywords: Electronic health records; Health disparities; Insomnia; Medication; Sleep disorders.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Black People / statistics & numerical data
  • Healthcare Disparities* / ethnology
  • Healthcare Disparities* / statistics & numerical data
  • Humans
  • Hypnotics and Sedatives* / administration & dosage
  • Hypnotics and Sedatives* / therapeutic use
  • Minority Groups / statistics & numerical data
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Racial Groups* / statistics & numerical data
  • Retrospective Studies
  • Sleep Initiation and Maintenance Disorders* / drug therapy
  • Sleep Initiation and Maintenance Disorders* / epidemiology
  • Time-to-Treatment* / statistics & numerical data
  • United States / epidemiology
  • White / statistics & numerical data


  • Hypnotics and Sedatives