Influence of depression on racial and ethnic disparities in diabetes control.
Influence of depression on racial and ethnic disparities in diabetes control.
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DOI：
10.1136/bmjdrc-2023-003612
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发表时间：
2023-11
影响因子：
4.1
通讯作者：
Washington, Donna L
中科院分区：
文献类型：
--
作者：
Breland, Jessica Y;Tseng, Chi-Hong;Toyama, Joy;Washington, Donna L
我们检验了抑郁症诊断影响糖尿病控制的种族和民族差异以及心理健康治疗缓和这种关系的假设。我们使用管理数据创建了一个退伍军人健康管理局（VHA）糖尿病患者的国家队列（n=815 067）。横断面线性混合效应回归模型检验了抑郁对糖尿病控制不良（糖化血红蛋白>9%）的假设间接效应，并检验了心理健康治疗（就诊或抗抑郁药处方）是否会调节抑郁的影响（α=0.05）。结果代表糖尿病控制不良概率的百分点差异。协变量包括初级保健访视、性别、年龄和VHA设施。总体而言，20%的队列糖尿病控制不良，22%患有抑郁症。抑郁症在种族和少数民族群体中更为常见。与白色患者相比，大多数少数族裔组的糖尿病控制不良概率较高（最大差异：美洲印第安人或阿拉斯加原住民患者，5.2%（95% CI 4.3%，6.0%））。由抑郁症引起的种族和民族差异比例的绝对值范围为0.2%（西班牙裔患者）至2.0%（亚裔患者），在考虑心理健康治疗的调节作用时具有相似的作用。抑郁症患者和5+心理健康访问有较低的可能性，糖尿病控制较差的访问相比，那些较少，无论抗抑郁药处方状态。抑郁症对糖尿病控制差异的影响很小。糖尿病患者，特别是少数种族和族裔群体的糖尿病患者抑郁症发病率高，这突出表明需要确保对这两种疾病进行公平和协调的护理，因为心理健康治疗的效果可能会扩展到身体健康状况的控制。
We tested the hypotheses that depression diagnoses influence racial and ethnic disparities in diabetes control and that mental health treatment moderates that relationship. We created a national cohort of Veterans Health Administration (VHA) patients with diabetes using administrative data (n=815 067). Cross-sectional linear mixed effects regression models tested the hypothesized indirect effect of depression on poor diabetes control (glycosylated hemoglobin >9%) and tested whether mental health treatment (visits or antidepressant prescriptions) moderated the effect of depression (α=0.05). Results represent the percentage point difference in probability of poor diabetes control. Covariates included primary care visits, sex, age, and VHA facility. Overall, 20% of the cohort had poor diabetes control and 22% had depression. Depression was more common among racial and ethnic minoritized groups. The probability of poor diabetes control was higher for most minoritized groups compared with White patients (largest difference: American Indian or Alaska Native patients, 5.2% (95% CI 4.3%, 6.0%)). The absolute value of the proportion of racial and ethnic disparities accounted for by depression ranged from 0.2% (for Hispanic patients) to 2.0% (for Asian patients), with similar effects when accounting for the moderating effect of mental health treatment. Patients with depression and 5+ mental health visits had a lower probability of poor diabetes control compared with those with fewer visits, regardless of antidepressant prescription status. The influence of depression on disparities in diabetes control was small. High rates of depression among people with diabetes, especially among those from racial and ethnic minoritized groups, highlight a need to ensure equitable and coordinated care for both conditions, as the effects of mental health treatment may extend to the control of physical health conditions.