Prevalence, adherence, and health care resource utilization in schizophrenia: A national and state-level analysis of US Medicaid Beneficiaries.

Abstract

Schizophrenia is a chronic and debilitating mental disorder that imposes substantial health care challenges, particularly among Medicaid beneficiaries. Despite the vulnerability of this population, a comprehensive understanding of national and state-level prevalence, adherence, and health care resource utilization (HCRU) remains limited. To estimate the prevalence of schizophrenia among Medicaid beneficiaries at national and state levels and to characterize their sociodemographic profiles, medication adherence, and HCRU across care settings. This retrospective cohort study used the Transformed Medicaid Statistical Information System Analytic Files from 2016 to 2022. Adults aged 18 years and older with at least 2 schizophrenia claims on separate dates were included. National and state-level prevalence analyses were conducted among all Medicaid beneficiaries, including Medicaid-only (beneficiaries enrolled exclusively in Medicaid) and dual-eligible beneficiaries (those enrolled in both Medicaid and Medicare). Descriptive analyses were conducted among Medicaid-only beneficiaries in the most recent study period (2022) to assess sociodemographic characteristics, adherence to antipsychotics (measured using the proportion of days covered [PDC], with adherence defined as PDC≥80%), and HCRU across settings, including inpatient and outpatient services, emergency department visits, and home health. From 2016 to 2022, the national prevalence of schizophrenia among all Medicaid beneficiaries decreased from 2.6% to 1.7%; however, the absolute number of affected individuals increased from 834,920 to 956,023, with California and New York reporting the largest patient populations. In 2022, a total of 143,970 Medicaid-only beneficiaries with schizophrenia were identified. The mean age was 41.9 years, with the largest proportion being male (56.4%) and non-Hispanic White (41.8%). Medication adherence was low, with fewer than 30% of patients with any antipsychotic prescription achieving a PDC greater than or equal to 80%. During the 12-month follow-up period, 44.9% of patients had at least 1 inpatient admission, and 54.6% of those hospitalized had at least 1 mental health-related admission. During the same 12-month period, 68.8% of patients had at least 1 mental health outpatient visit, with a mean of 30.6 visits among those with any mental health outpatient care. Schizophrenia remains highly prevalent in the Medicaid population at both national and state levels and continues to place substantial demands on the health care system. Low medication adherence and high HCRU among this population highlight ongoing unmet needs. These findings emphasize the need for targeted, system-level strategies to improve access, adherence, and coordinated care for individuals with schizophrenia within Medicaid programs.