Skaer T L, Sclar D A, Robison L M, Galin R S
Pharmacoeconomics and Pharmacoepidemiology Research Unit, College of Pharmacy, Washington State University, Pullman 99164-6510, USA.
Clin Ther. 2000 Dec;22(12):1575-89. doi: 10.1016/s0149-2918(00)83055-6.
This study was undertaken to determine ethnicity/race-specific (white, black, and Hispanic) population-adjusted rates of US office-based physician visits in which a diagnosis of a depressive disorder was recorded or in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed.
Data from the National Ambulatory Medical Care Survey for 1992 through 1997 were partitioned into three 2-year periods: 1992-1993, 1994-1995, and 1996-1997. For each 2-year period, data from office-based physician visits for patients aged 20 to 79 years were extracted to assess, by ethnicity/race, (1) the number of visits in which a diagnosis of a depressive illness was recorded (International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.2-296.36, 300.4, or 311) and (2) the number of visits in which a diagnosis of a depressive illness was recorded and antidepressant pharmacotherapy was prescribed. We calculated ethnicity/race-specific rates (per 100 US population aged 20 to 79 years) of office-based visits in which a diagnosis of a depressive disorder was recorded and in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed. The specialty of the reporting physician and the proportion of patients receiving a selective serotonin reuptake inhibitor (SSRI) were also discerned.
From 1992-1993 to 1996-1997, the rate of office-based visits (per 100 US population aged 20 to 79 years) in which a diagnosis of a depressive disorder was recorded increased 3.7% for whites (from 10.9 to 11.3; P = 0.001), 31.0% for blacks (from 4.2 to 5.5; P = 0.001), and 72.9% for Hispanics (from 4.8 to 8.3; P = 0.001). The rate of office-based visits in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed increased 18.5% for whites (from 6.5 to 7.7 per 100; P = 0.001), 38.5% for blacks (from 2.6 to 3.6 per 100; P = 0.001). and 106.7% for Hispanics (from 3.0 to 6.2 per 100; P = 0.001). Between 1992-1993 and 1996-1997, use of an SSRI increased among whites and blacks (from 50.0% to 65.8% and from 40.5% to 58.2%, respectively), but declined among Hispanics (from 51.4% to 48.6%; all comparisons P = 0.001).
By 1996-1997, the population-adjusted rates for Hispanics were within a quartile of those observed for whites, whereas the rates for blacks remained at less than half those observed in whites. The observed divergence in population-adjusted rates by ethnicity/race may reflect the nature of the patient-physician relationship, sensitivity and specificity of diagnostic techniques and instruments, and the wider social context in which an office-based visit occurs, including access to and type of health insurance and coverage for mental health services.
本研究旨在确定按种族/族裔（白人、黑人及西班牙裔）调整后的美国门诊医生诊疗率，这些诊疗记录了抑郁症诊断，或记录了抑郁症诊断并开具了抗抑郁药物治疗处方。
1992年至1997年的国家门诊医疗调查数据被分为三个两年期：1992 - 1993年、1994 - 1995年和1996 - 1997年。对于每个两年期，提取20至79岁患者门诊医生诊疗的数据，按种族/族裔评估：（1）记录了抑郁症诊断的诊疗次数（国际疾病分类第九版临床修订本编码296.2 - 296.36、300.4或311），以及（2）记录了抑郁症诊断并开具了抗抑郁药物治疗处方的诊疗次数。我们计算了按种族/族裔调整后的（每100名20至79岁美国人口）门诊诊疗率，这些诊疗记录了抑郁症诊断，以及记录了抑郁症诊断并开具了抗抑郁药物治疗处方。还辨别了报告医生的专业以及接受选择性5-羟色胺再摄取抑制剂（SSRI）治疗的患者比例。
从1992 - 1993年到1996 - 1997年，记录了抑郁症诊断的门诊诊疗率（每100名20至79岁美国人口），白人增加了3.7%（从10.9增至11.3；P = 0.001），黑人增加了31.0%（从4.2增至5.5；P = 0.001），西班牙裔增加了72.9%（从4.8增至8.3；P = 0.001）。记录了抑郁症诊断并开具了抗抑郁药物治疗处方的门诊诊疗率，白人增加了18.5%（从每100人6.5增至7.7；P = 0.001），黑人增加了38.5%（从每100人2.6增至3.6；P = 0.001），西班牙裔增加了106.7%（从每100人3.0增至6.2；P = 0.001）。在1992 - 1993年至1996 - 1997年期间，白人及黑人中SSRI的使用增加（分别从50.0%增至65.8%和从40.5%增至58.2%），但西班牙裔中SSRI的使用减少（从51.4%降至48.6%；所有比较P = 0.001）。
到1996 - 1997年，西班牙裔经人口调整后的诊疗率处于白人观察值的四分位范围内，而黑人的诊疗率仍不到白人的一半。观察到的按种族/族裔调整后的诊疗率差异可能反映了医患关系的性质、诊断技术和工具的敏感性及特异性，以及门诊诊疗所发生的更广泛社会背景，包括医疗保险的可及性和类型以及心理健康服务的覆盖范围。
