INSERM, U912 SESSTIM, Marseille, France.
Ann Epidemiol. 2013 Mar;23(3):99-105. doi: 10.1016/j.annepidem.2012.12.008. Epub 2013 Jan 10.
To determine whether social inequalities in new antidepressant treatment exist at the individual and/or neighborhood level; and their relation to access to prescribers and/or processes of care (treatment initiation and duration).
We followed 316,412 inhabitants of Marseilles (aged 18-64 years) covered by the National Health Insurance Fund for 2.5 years. We analyzed new treatments (≥1 purchase of antidepressants and none in the 6 months before the first one), and new long treatments (≥4 within 6 months after the first purchase). We tested their associations with high individual disadvantage and census block deprivation in a multivariate, multilevel logistic model adjusted for consultations with general practitioners and psychiatrists to control for access to care.
High individual disadvantage was not associated with the probability of new treatments, but it was with lower odds of receiving new long treatments. Residing in deprived census blocks was associated with lower odds of receiving treatment for both dependent variables.
Our results suggest that social inequalities at the individual and neighborhood levels in new antidepressant treatment occur in access to specialty care and in treatment initiation and affect its duration. Further research is warranted to improve our understanding of their mechanisms.
确定新的抗抑郁治疗是否存在于个体和/或社区层面的社会不平等现象；以及它们与获得处方者和/或护理过程（治疗开始和持续时间）的关系。
我们对马赛（年龄在 18-64 岁）的 316412 名居民进行了为期 2.5 年的随访。我们分析了新的治疗方法（≥1 次购买抗抑郁药，且在首次购买前 6 个月内没有购买）和新的长期治疗方法（≥4 次在首次购买后的 6 个月内）。我们在多变量、多层次逻辑模型中测试了它们与高个体劣势和人口普查块剥夺之间的关联，该模型调整了全科医生和精神科医生的咨询次数，以控制获得护理的机会。
高个体劣势与新治疗的可能性无关，但与接受新长期治疗的可能性较低有关。居住在贫困人口普查块的人接受这两种因变量治疗的可能性都较低。
我们的研究结果表明，新的抗抑郁治疗在获得专科护理和治疗开始以及影响治疗持续时间方面存在个体和社区层面的社会不平等现象。需要进一步研究以加深我们对其机制的理解。
