Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, MO; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO.
J Am Med Dir Assoc. 2017 Dec 1;18(12):1058-1062. doi: 10.1016/j.jamda.2017.09.027.
The Institute of Medicine has highlighted unequal treatment for African American individuals in health care. We examined the association of underuse of antidepressants in African American individuals with increased mortality.
We conducted a longitudinal cohort study in Metropolitan St Louis, Missouri, in a population-based study of community-dwelling African American individuals, aged 52 to 68 years. Medication evaluations and clinically relevant levels of depressive symptoms (CRLDS) assessments occurred in 2000 and 2004. The analytic sample included 830 (of 853 total, 97%) participants with complete data. CRLDS was defined as ≥9 on the 11-item Center for Epidemiologic Studies Depression scale. Antidepressant use was determined by in-home medication recording and in-center coding. Participants were placed into 4 exposure categories: persistent CRLDS-no antidepressant (n = 69); intermittent CRLDS-no antidepressant (n = 123); antidepressant treatment (n = 110); and no CRLDS-no antidepressant (n = 528). Logistic regression with backwards elimination of the 9 identified potential confounders was used to examine associations of exposures with all-cause mortality over 6 years (2004-2010). Five sensitivity analyses investigated robustness of the primary findings.
The antidepressant group was independently associated with reduced mortality compared with the persistent-no antidepressant group (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08-0.44). Sensitivity analyses showed no substantive differences from the primary model; one indicated that the persistent CRLDS-no antidepressant group experienced significantly increased mortality compared with the no CRLDS-no antidepressant group (OR 2.12, 95% CI 1.10-4.09), whereas the intermittent-no antidepressant group did not (OR 0.83, 95% CI 0.44-1.58).
These results highlight that underuse of antidepressants in African American individuals is associated with increased mortality.
美国医学研究所强调了非裔美国人在医疗保健中受到不平等对待的问题。我们研究了抗抑郁药在非裔美国人中使用不足与死亡率增加之间的关系。
我们在密苏里州圣路易斯都会区进行了一项纵向队列研究，对年龄在 52 至 68 岁的社区居住的非裔美国人群进行了一项基于人群的研究。药物评估和临床相关的抑郁症状水平（CRLDS）评估分别在 2000 年和 2004 年进行。分析样本包括 830 名（共 853 名，97%）完成数据的参与者。CRLDS 定义为 11 项流行病学研究中心抑郁量表的≥9 分。抗抑郁药的使用情况通过家庭用药记录和中心编码确定。参与者被分为 4 个暴露类别：持续存在 CRLDS 且未使用抗抑郁药（n=69）；间歇性 CRLDS 且未使用抗抑郁药（n=123）；抗抑郁药治疗（n=110）；以及无 CRLDS 且未使用抗抑郁药（n=528）。使用向后逐步消除 9 个确定的潜在混杂因素的逻辑回归，来检查暴露与 6 年内全因死亡率（2004-2010 年）之间的关联。进行了 5 项敏感性分析，以调查主要发现的稳健性。
与持续存在 CRLDS 且未使用抗抑郁药组相比，使用抗抑郁药组的死亡率独立降低（比值比 [OR] 0.19，95%置信区间 [CI] 0.08-0.44）。敏感性分析结果与主要模型没有实质性差异；其中一项分析表明，持续存在 CRLDS 且未使用抗抑郁药组的死亡率明显高于无 CRLDS 且未使用抗抑郁药组（OR 2.12，95%CI 1.10-4.09），而间歇性 CRLDS 且未使用抗抑郁药组则不然（OR 0.83，95%CI 0.44-1.58）。
这些结果强调了非裔美国人中抗抑郁药使用不足与死亡率增加之间的关系。
