Regional disparities in clozapine dispensing in Brazil: associations with specialized mental health care

Braz J Psychiatry. 2026 Nov 9. doi: 10.47626/1516-4446-2026-5196. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate state-level disparities in clozapine dispensing in Brazil and their relationship with specialized mental health services and human development.

METHODS: We performed a nationwide ecological cross-sectional analysis using 2024 clozapine dispensing data from the Brazilian Unified Health System. The study included dispensing events for individuals aged 16 years or older with schizophrenia and schizoaffective disorder. State-level clozapine dispensing rates were compared with mental health and primary care indicators, including psychiatrist density, inpatient beds, Psychosocial Care Centers, Family Health Teams, primary care coverage, and HDI. Correlations were tested with Spearman’s coefficient, followed by multivariable linear regression and mediation analysis.

RESULTS: We identified 3,240,406 antipsychotic dispensing events. Clozapine dispensing varied substantially across states, ranging from 15.54 to 361.24 per 100,000 inhabitants. Clozapine dispensing was positively correlated with psychiatrist density, psychiatric inpatient beds, and HDI. In the multivariable model, only psychiatrist density remained independently associated with higher clozapine dispensing (B = 12.4, 95% CI 0.77-24.1; p = 0.038).

CONCLUSIONS: State-level clozapine dispensing was more strongly associated with specialized mental health care capacity than with primary care services. These findings suggest a possible association between psychiatrist availability and clozapine dispensing within SUS, which should be examined in future research.

PMID:43002659 | DOI:10.47626/1516-4446-2026-5196