Anderson Kelly K, McKenzie Kwame J, Kurdyak Paul
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada.
Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
Soc Psychiatry Psychiatr Epidemiol. 2017 Aug;52(8):949-961. doi: 10.1007/s00127-017-1403-z. Epub 2017 Jun 10.
Some ethnic groups have more negative contacts with health services for first-episode psychosis, likely arising from a complex interaction between ethnicity, socio-economic factors, and immigration status. Using population-based health administrative data, we sought to examine the effects of ethnic group and migrant status on patterns of health service use preceding a first diagnosis of schizophrenia or schizoaffective disorder among people aged 14-35 over a 10-year period.
We compared access to care and intensity of service use for first-generation ethnic minority groups to the general population of Ontario. To control for migrant status, we restricted the sample to first-generation migrants and compared service use indicators for ethnic minority groups to the European migrant group.
Our cohort included 18,080 people with a first diagnosis of schizophrenia or schizoaffective disorder, of whom 14.4% (n = 2607) were the first-generation migrants. Our findings suggest that the magnitude of ethnic differences in health service use is reduced and no longer statistically significant when the sample is restricted to first-generation migrants. Of exception, nearly, all migrant groups have lower intensity of primary care use, and Caribbean migrants are consistently less likely to use psychiatric services.
We observed fewer ethnic differences in health service use preceding the first diagnosis of psychosis when patterns are compared among first-generation migrants, rather than to the general population, suggesting that the choice of reference group influences ethnic patterning of health service use. We need a comprehensive understanding of the mechanisms behind observed differences for minority groups to adequately address disparities in access to care.
一些种族群体在首次发作精神病时与医疗服务的接触更为负面，这可能源于种族、社会经济因素和移民身份之间的复杂相互作用。利用基于人群的健康管理数据，我们试图研究种族群体和移民身份对14至35岁人群在首次诊断为精神分裂症或分裂情感性障碍之前10年期间医疗服务使用模式的影响。
我们将第一代少数族裔群体的就医机会和服务使用强度与安大略省的普通人群进行了比较。为了控制移民身份，我们将样本限制为第一代移民，并将少数族裔群体的服务使用指标与欧洲移民群体进行了比较。
我们的队列包括18080名首次诊断为精神分裂症或分裂情感性障碍的患者，其中14.4%（n = 2607）为第一代移民。我们的研究结果表明，当样本仅限于第一代移民时，医疗服务使用中的种族差异程度会降低，且不再具有统计学意义。例外的是，几乎所有移民群体的初级保健使用强度都较低，而加勒比移民使用精神科服务的可能性一直较低。
当在第一代移民中比较模式，而不是与普通人群比较时，我们观察到在首次诊断精神病之前的医疗服务使用中种族差异较少，这表明参考群体的选择会影响医疗服务使用的种族模式。我们需要全面了解观察到的少数群体差异背后的机制，以便充分解决就医机会方面的差距。
