Retrospective Cohort Study of Racial-Ethnic Disparities in Receipt of Electroconvulsive Therapy, 2016-2021.

Objective: Electroconvulsive therapy (ECT) is an effective treatment for severe depression, but racial-ethnic disparities in its receipt have long been observed, and previous studies have had limited generalizability. This study aimed to determine whether racial-ethnic disparities persist in contemporary treatment environments after adjustment for various demographic factors.

Methods: A retrospective study was conducted among patients with data in the HCA Healthcare Enterprise Data Warehouse who were diagnosed as having severe unipolar depression (ICD-10 codes F32-F33) and who sought care in any of 162 inpatient and outpatient facilities between 2016 and 2021. Patients were grouped by self-reported racial-ethnic identity. The association between race-ethnicity and selected covariates was determined by using chi-square tests (α=0.05), and the relationship between race-ethnicity and ECT receipt, given selected predictor variables, was estimated by using logistic regression.

Results: Analyses were conducted for 19,011 unique patients. Significant variation by race-ethnicity was found for all covariates (p<0.001). ECT was administered to 3% of White patients and 1% of non-White patients. Compared with all other race-ethnicities, the unadjusted odds ratio for ECT receipt among White patients was 3.12 (p<0.001). Patients from each non-White racial-ethnic group had significantly lower rates of ECT receipt compared with White patients, including Asian (adjusted OR [aOR]=0.43, p<0.001), Black (aOR=0.27, p<0.001), and Hispanic (aOR=0.39, p<0.001) patients and patients identifying as other race-ethnicity (aOR=0.53, p=0.001).

Conclusions: In this nationwide study, significant disparities in ECT use, by self-identified racial-ethnic identity, were observed even after demographic covariates were controlled.