Exploring racial disparity in post-traumatic stress disorder diagnosis: Implications for care of African American women
Exploring racial disparity in post-traumatic stress disorder diagnosis: Implications for care of African American women
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DOI：
10.1177/0884217505278296
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发表时间：
2005-07-01
影响因子：
1.8
通讯作者：
Odera, LA
中科院分区：
文献类型：
--
作者：
Seng, JS;Kohn-Wood, LP;Odera, LA
目的：通过使用一个仅限于贫困妇女的数据集，在控制性别和类别的同时，探索导致非裔美国人和白人美国人之间创伤后应激障碍(PTSD)诊断差异的因素。设计：一项横断面流行病学二次分析。背景：1994年至1997年的密歇根州医疗补助服务费用索赔数据。样本：总共20,298名非裔美国人和白人美国青少年和成年妇女，其中包括2,996名被诊断为创伤后应激障碍的人。主要观察指标：受害情况，PTSD诊断，精神和躯体并存，以及PTSD治疗。结果：非洲裔美国妇女在被诊断为PTSD的组中代表性不足(12%比对照组中31%)，尽管强奸和殴打的住院率相同。他们不太可能被诊断为与复杂的创伤后应激障碍相关的共病，如分离性障碍(OR=0.259，p；001)或边缘人格障碍(OR=0.178，p<；.001)，但被诊断为品行障碍、精神分裂症或药物滥用的可能性相同。非裔美国女性获得连续保险的可能性降低了40%。结论：患者、提供者和系统因素似乎相互作用，造成了创伤后应激障碍诊断和治疗的差异。关注病例发现和提供者或系统偏见可能有助于缩小差距。
Objective: To explore factors contributing to disparities in posttraumatic stress disorder (PTSD) diagnosis between African Americans and White Americans, while controlling for gender and class by using a data set limited to poor women.Design: A cross-sectional epidemiological secondary analysis.Setting: Michigan Medicaid fee-for-service claims data from 1994 through 1997.Sample: A total of 20,298 African American and White American adolescents and adult women, including 2,996 with PTSD diagnosis.Main outcome measures: Victimization, PTSD diagnosis, psychiatric and somatic comorbidities, and PTSD treatment.Results: African American women were under-represented in the group diagnosed with PTSD (12% versus 31% in the comparison group), despite having equal rates of hospitalization for rape and battering. They were less likely to be diagnosed with comorbidities associated with complex PTSD, such as dissociative disorder (OR = 0.259, p < .001) or borderline personality disorder (OR = 0.178, p < .001), but were equally likely to be diagnosed with conduct disorder, schizophrenia, or substance abuse. African American women were 40% less likely to have continuous insurance coverage.Conclusions: Patient, provider, and system factors appear to interact to create disparities in PTSD diagnosis and treatment. Attention to case finding and provider or system bias may help reduce disparities.