Matheson Flora I, Smith Katherine L W, Fazli Ghazal S, Moineddin Rahim, Dunn James R, Glazier Richard H
Centre for Research on Inner City Health at The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Centre for Research on Inner City Health at The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
J Epidemiol Community Health. 2014 Oct;68(10):971-8. doi: 10.1136/jech-2014-203844. Epub 2014 Jun 25.
People with comorbid mental and physical illness (PI) experience worse health, inadequate care and increased mortality relative to those without mental illness (MI). The role of gender in this relationship is not fully understood. This study examined gender differences in onset of mental health service usage among people with physical illness (COPD, asthma, hypertension and type II diabetes) compared with a control cohort.
We used a unique linked dataset consisting of the 2000-2001 Canadian Community Health Survey and medical records (n=17 050) to examine risk of onset of MI among those with and without PI among Ontario residents (18-74 years old) over a 10-year period (2002-2011). Adjusted COX proportional survival analysis was conducted.
Unadjusted use of MI medical services in the PI cohort was 55.6% among women and 44.7% (p=0.0001) among men; among controls 48.1% of the women and 36.7% of the men used MI medical services (p=0.0001). The relative risk of usage among women in the PI group relative to controls was 1.16. Among men, the relative risk was 1.22. Women were 1.45 times more likely to use MI medical services relative to men (HR=1.45, CI 1.35 to 1.55). Respondents in the PI cohort were 1.32 times more likely to use MI medical services (HR=1.32, CI 1.23 to 1.42) relative to controls. Women in the PI cohort used MI medical services 6.4 months earlier than PI males (p=0.0059). In the adjusted model, women with PI were most likely to use MI medical services, followed by women controls, men with PI and men controls. There was no significant interaction between gender and PI cohort.
Further, gender-based research focusing on onset of usage of MI services among those with and without chronic health problems will enable better understanding of gender-based health disparities to improve healthcare quality, delivery and public health policy.
与无精神疾病（MI）的人相比，患有精神和身体共病的人（PI）健康状况更差，护理不足且死亡率更高。性别在这种关系中的作用尚未完全明确。本研究调查了患有身体疾病（慢性阻塞性肺疾病、哮喘、高血压和II型糖尿病）的人与对照组相比在使用心理健康服务方面的性别差异。
我们使用了一个独特的关联数据集，该数据集由2000 - 2001年加拿大社区健康调查和医疗记录（n = 17050）组成，以研究安大略省居民（18 - 74岁）在10年期间（2002 - 2011年）有PI和无PI人群中MI发病的风险。进行了调整后的COX比例生存分析。
PI队列中未调整的女性使用MI医疗服务的比例为55.6%，男性为44.7%（p = 0.0001）；对照组中48.1%的女性和36.7%的男性使用MI医疗服务（p = 0.0001）。PI组中女性相对于对照组使用MI医疗服务的相对风险为1.16。男性中，相对风险为1.22。女性使用MI医疗服务的可能性是男性的1.45倍（风险比 = 1.45，置信区间1.35至1.55）。PI队列中的受访者使用MI医疗服务的可能性是对照组的1.32倍（风险比 = 1.32，置信区间1.23至1.42）。PI队列中的女性比PI男性提前6.4个月使用MI医疗服务（p = 0.0059）。在调整模型中，患有PI的女性最有可能使用MI医疗服务，其次是女性对照组、患有PI的男性和男性对照组。性别与PI队列之间没有显著的交互作用。
此外，针对有无慢性健康问题人群使用MI服务的发病情况开展基于性别的研究，将有助于更好地理解基于性别的健康差异，从而改善医疗质量、医疗服务提供和公共卫生政策。
