Health Services Research Program, Emma Pendleton Bradley Hospital, East Providence, RI 02915, United States.
J Affect Disord. 2012 Feb;136(3):359-65. doi: 10.1016/j.jad.2011.11.026. Epub 2011 Dec 12.
Black Americans with depression were less likely to receive electroconvulsive therapy (ECT) than whites during the 1970s and 80s. This pattern was commonly attributed to treatment of blacks in lower quality hospitals where ECT was unavailable. We investigated whether a racial difference in receiving ECT persists, and, if so, whether it arises from lesser ECT availability or from lesser ECT use within hospitals conducting the procedure.
Black or white inpatient stays for recurrent major depression from 1993 to 2007 (N=419,686) were drawn from an annual sample of US community hospital discharges. The marginal disparity ratio estimated adjusted racial differences in the probabilities of (1) admission to a hospital capable of conducting ECT (availability), and (2) ECT utilization if treated where ECT is conducted (use).
Across all hospitals, the probability of receiving ECT for depressed white inpatients (7.0%) greatly exceeded that for blacks (2.0%). Probability of ECT availability was slightly greater for whites than blacks (62.0% versus 57.8%), while probability of use was markedly greater (11.8% versus 3.9%). The white versus black marginal disparity ratio for ECT availability was 1.07 (95% confidence interval 1.06-1.07) and stable over the period, while the ratio for use fell from 3.2 (3.1-3.4) to 2.5 (2.4-2.7).
Depressed persons treated in outpatient settings or receive no care are excluded from analyses.
Depressed black inpatients continue to be far less likely than whites to receive ECT. The difference arises almost entirely from lesser use of ECT within hospitals where it is available.
在 20 世纪 70 年代和 80 年代，患有抑郁症的美国黑人接受电痉挛疗法 (ECT) 的比例低于白人。这种模式通常归因于黑人在质量较低的医院接受治疗，而这些医院无法提供 ECT。我们调查了接受 ECT 是否存在种族差异，如果存在，这种差异是由于 ECT 可及性较低，还是由于在进行该程序的医院中 ECT 使用率较低所致。
从美国社区医院每年的样本中抽取了 1993 年至 2007 年因复发性重度抑郁症住院的黑人或白人住院患者（n=419686）。边际差异比估计了接受 ECT 的可能性（1）接受能够进行 ECT 的医院治疗的可能性（可用性），以及（2）如果在进行 ECT 的医院接受治疗则进行 ECT 治疗的可能性（使用）。
在所有医院中，接受 ECT 治疗的抑郁白人住院患者（7.0%）的概率大大超过黑人（2.0%）。白人接受 ECT 的可能性略高于黑人（62.0%对 57.8%），而黑人接受 ECT 的可能性则明显更高（11.8%对 3.9%）。ECT 可用性的白人与黑人边际差异比为 1.07（95%置信区间为 1.06-1.07），且在整个期间保持稳定，而使用的比率从 3.2（3.1-3.4）下降到 2.5（2.4-2.7）。
未接受门诊治疗或未接受治疗的抑郁患者被排除在分析之外。
接受 ECT 治疗的抑郁黑人住院患者继续远远低于白人。这种差异几乎完全是由于在可获得 ECT 的医院中 ECT 的使用率较低所致。
