Inequalities in the Incidence of Psychotic Disorders Among Racial and Ethnic Groups.
Inequalities in the Incidence of Psychotic Disorders Among Racial and Ethnic Groups.
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种族和民族群体中精神障碍发病率的不平等。
DOI：
10.1176/appi.ajp.20220917
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Paksarian,Diana
中科院分区：
文献类型：
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作者：
Chung,Winston;Jiang,Sheng-Fang;Milham,MichaelP;Merikangas,KathleenR;Paksarian,Diana
作者研究了最近六个种族/民族中精神障碍发病率，人口统计学特征以及共病精神病和医疗状况的趋势。方法回顾性队列研究设计用于检查2009年至2019年北方加州凯撒医疗机构成员中种族/民族精神障碍的发病率以及共病精神病和医疗状况。（N= 5 994 758）。Poisson回归被用来评估每年发病率的变化，考克斯比例风险和logistic回归模型调整年龄和性别被用来测试相关性和consequence.ResultsOverall，非情感性精神障碍的发病率略有下降，在研究期间。与白色成员相比，黑人中非情感性精神病诊断的风险更高（风险比=2.13，95% CI=2.02-2.24）和美洲印第安人或阿拉斯加原住民（AIAN）（风险比=1.85，95% CI=1.53-2.23），亚洲人中风险比更低（风险比=0.72，95% CI=0.68-0.76）和西班牙裔（风险比=0.91，95% CI=0.87-0.96）成员，以及人种/种族被归类为“其他”的成员（风险比=0.92，95% CI=0.86-0.99）。与白色成员相比，黑人经年龄和性别调整后的情感性精神病诊断风险更高（风险比=1.76，95% CI=1.62-1.91），西班牙裔（风险比=1.09，95% CI=1.02-1.16），和AIAN（风险比=1.38，95% CI=1.00-1.90），亚洲人中风险更低（风险比=0.77，95% CI=0.71-0.83），夏威夷原住民或其他太平洋岛民（风险比=0.69，95%CI =0.48-0.99）和“其他”（风险比=0.86，95%CI =0.77-0.96）成员。精神障碍与自杀几率显著增高相关（比值比=2.65，95% CI=2.15-3.28），过早死亡（比值比=1.30，95% CI=1.22-1.39），（比值比=1.64，95% CI=1.55-1.72）和较低的卫生保健利用率（比值比=0.44，95%CI =0.42-0.47）。结论这项研究表明，在美国，精神病性障碍的诊断存在种族和民族差异，与非西班牙裔白人相比。被诊断患有精神病的人面临着更大的其他负面健康结果的负担和更低的医疗保健利用率，反映了个人和经济影响。确定亚组中发病率升高的风险因素和保护性影响可以为预防和干预策略提供信息，以改善精神病综合征的严重后果。
ObjectiveThe authors examined recent trends in incidence of psychotic disorders, demographic characteristics, and comorbid psychiatric and medical conditions among six racial/ethnic groups.MethodA retrospective cohort study design was used to examine the incidence of psychotic disorders across race/ethnicity groups and comorbid psychiatric and medical conditions among members of Kaiser Permanente Northern California from 2009 to 2019 (N=5,994,758). Poisson regression was used to assess changes in annual incidence, and Cox proportional hazards and logistic regression models adjusted for age and sex were used to test correlates and consequences.ResultsOverall, the incidence of nonaffective psychotic disorders decreased slightly over the study period. Compared with White members, the risk of nonaffective psychosis diagnosis was higher among Black (hazard ratio=2.13, 95% CI=2.02–2.24) and American Indian or Alaskan Native (AIAN) (hazard ratio=1.85, 95% CI=1.53–2.23) members and lower among Asian (hazard ratio=0.72, 95% CI=0.68–0.76) and Hispanic (hazard ratio=0.91, 95% CI=0.87–0.96) members, as well as those whose race/ethnicity was categorized as “other” (hazard ratio=0.92, 95% CI=0.86–0.99). Compared with White members, the risk of affective psychosis diagnosis adjusted for age and sex was higher among Black (hazard ratio=1.76, 95% CI=1.62–1.91), Hispanic (hazard ratio=1.09, 95% CI=1.02–1.16), and AIAN (hazard ratio=1.38, 95% CI=1.00–1.90) members and lower among Asian (hazard ratio=0.77, 95% CI=0.71–0.83), Native Hawaiian or other Pacific Islander (hazard ratio=0.69, 95% CI=0.48–0.99), and “other” (hazard ratio=0.86, 95% CI=0.77–0.96) members. Psychotic disorders were associated with significantly higher odds of suicide (odds ratio=2.65, 95% CI=2.15–3.28), premature death (odds ratio=1.30, 95% CI=1.22–1.39), and stroke (odds ratio=1.64, 95% CI=1.55–1.72) and lower odds of health care utilization (odds ratio=0.44, 95% CI=0.42–0.47).ConclusionsThis study demonstrates racial and ethnic variation in incident psychotic disorder diagnoses in the United States, compared with non-Hispanic Whites. Individuals diagnosed with psychosis face a greater burden of other negative health outcomes and lower odds of health care utilization, reflecting personal and economic impacts. Identifying risk factors for elevated rates and protective influences in subgroups can inform strategies for prevention and interventions to ameliorate severe consequences of psychotic syndromes.