Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression
Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression
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DOI：
10.1007/s40615-020-00774-y
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发表时间：
2020-05-30
影响因子：
3.9
通讯作者：
Butwick, Alexander J.
中科院分区：
文献类型：
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作者：
Chan, Avis L.;Guo, Nan;Butwick, Alexander J.
目的评估产后抑郁症患者住院护理发生率的种族和民族差异。方法这是一项采用《国际疾病分类第九版临床修改》(ICD-9-CM)诊断代码的回顾性队列研究，数据来自加利福尼亚州的全州规划和发展办公室。我们纳入了2008至2012年间住院分娩的初产妇女。主要结果是产后医院在产后9个月内首次遇到抑郁症的ICD-9-CM代码。我们检查了以医院为基础的护理按种族/民族分类的产后抑郁症的累积发病率。用Logistic回归估计相对危险度。结果984,167名初产妇女中，非西班牙裔白人314,037人(32%)，非西班牙裔黑人59,754人(6%)，非西班牙裔亚裔150,855人(15%)，西班牙裔448,770人(46%)，其他种族10,399人(1%)。以医院为基础的护理产后抑郁症的累积发病率在黑人妇女中最高(39；95%CI=每10,000次分娩中34-44)，在亚洲妇女中最低(7；95%CI=每10,000次分娩中5-8次)。与白人女性相比，黑人女性更有可能获得以医院为基础的产后抑郁症治疗(OR=2.3；95%CI=1.9-2.7)，而亚裔(OR=0.4；95%CI=0.3-0.5)和西班牙裔(OR=0.8；95%CI=0.7-1.0)的护理可能性较小。在排除了患有产前抑郁症的妇女，根据社会人口和临床变量进行调整，并根据护理环境进行分层后，也观察到了类似的结果。结论与白人女性相比，以医院为基础的产后抑郁症治疗对黑人女性的影响更大。确定和改善产后妇女在获得和利用精神卫生保健方面的不平等现象应成为产妇保健的优先事项。
Objective To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. Methods This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. Results The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. Conclusion Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.