Examining racial disparity in psychotic disorders related ambulatory care visits: an observational study using national ambulatory medical care survey 2010–2015

BMC Psychiatry

Research

Deyu Pan¹  Magda Shaheen²  Denese Shervington³  David Hampton⁴  Shahrzad Bazargan-Hejazi⁵  Anaheed Shirazi⁶  Gul Ebrahim⁷  Daniel Askharinam⁸ 

[1] Charles R Drew University of Medicine and Science, Los Angeles, CA, USA;College of Medicine, Charles R. Drew University of Medicine and Science, UCLA David Geffen School of Medicine, Los Angeles, CA, USA;Department Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA;Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA;Department of Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science and UCLA David Geffen School of Medicine, Los Angeles, CA, USA;Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA;Kedren Community Care Clinic and Charles R Drew University of Medicine and Science, Los Angeles, CA, USA;Kedren Community Health Care Center, Los Angeles, CA, USA;

关键词: Racial disparity;    Psychotic Disorders;    Ambulatory care visits;   

DOI  :  10.1186/s12888-023-05095-y

 received in 2022-06-01, accepted in 2023-08-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundOne of the most consistent research findings related to race and mental health diseases is the disproportionately high rate of psychotic disorder diagnoses among people of color, specifically people of African descent. It is important to examine if a similar pattern exists among specific psychotic disorders. We aimed to examine the racial/ethnic differences in ambulatory care visits diagnosed with schizophrenia-spectrum disorders (SSDs).MethodsWe analyzed data from the National Ambulatory Medical Care Survey (NAMCS) 2010–2015. The study sample included physician office-based visits by individuals diagnosed with SSDs, including schizophrenia, schizoaffective, and unspecified psychotic disorder (n = 1155). We used descriptive and bivariate analysis by race/ethnicity and three multinomial logistic regression models to test the association between the SSDs and race/ethnicity, adjusting for age, gender, insurance, disposition, medication Rx, and co-morbidity, considering the design and weight.ResultOf the 1155 visits for SSDs, 44.8% had schizophrenia, 37.4% had schizoaffective disorder diagnosis, and 19.0% had unspecified psychosis disorder. We found significant racial disparities in the diagnosis of SSDs. Black patients were overrepresented in all three categories: schizophrenia (24%), schizoaffective disorder (17%), and unspecified psychosis disorder (26%). Also, a notable percentage of Black patients (20%) were referred to another physician in cases of schizophrenia compared to other ethnoracial groups (p < 0.0001). Moreover, we found a significant disparity in insurance coverage for schizoaffective disorder, with a higher percentage of Black patients (48%) having Medicaid insurance compared to patients from other ethnoracial groups (p < 0.0001). Black patients had nearly twice the odds of receiving a diagnosis of schizophrenia compared to White patients [AOR = 1.94; 95% CI: 1.28–2.95; P = 0.001]. However, they had significantly lower odds of being diagnosed with schizoaffective disorder [AOR = 0.42, 95% CI: 0.26–0.68; P = 0.003]. Race/ethnicity was not associated with receiving an unspecified psychosis disorder.ConclusionsOur results show that SSDs, more specifically schizophrenia, continue to burden the mental health of Black individuals. Validation of our findings requires rigorous research at the population level that reveals the epidemiological difference of SSDs diagnoses in different race/ethnicity groups. Also, advancing our understanding of the nature of disparity in SSDs diagnoses among the Black population requires disentangling etiologic and systemic factors in play. This could include psychological stress, the pathway to care, services use, provider diagnostic practice, and experiencing discrimination and institutional and structural racism.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023