Rivierduinen, Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ, Leiden, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, the Netherlands.
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Soc Sci Med. 2018 Aug;211:87-94. doi: 10.1016/j.socscimed.2018.06.005. Epub 2018 Jun 12.
A higher own-group ethnic density in the area of residence is often associated with a lower risk for psychotic disorder. For common mental disorders the evidence is less convincing. This study explores whether these findings are mirrored in data on dispensing of antipsychotics and antidepressants.
Health insurance data on dispensed medication among all adults living in the four largest Dutch cities were linked to demographic data from Statistics Netherlands. Dispensing of antipsychotics and antidepressants in 2013 was analyzed in relation to the proportion of the own ethnic group in the neighborhood.
Higher own-group ethnic density was associated with lower dispensing of antipsychotics among the Moroccan-Dutch (N = 115,455), after adjusting for age, gender, and SES of the neighborhood (OR for the highest vs. the lowest density quintile = 0.72 [0.66-0.79]). However, this association vanished after adjustment for household composition (OR = 0.93 [0.85-1.03]). Similar results were found for the Turkish-Dutch (N = 105,460) (OR = 0.86 [0.76-0.96] and 1.05 [0.94-1.18]). For those of Surinamese (N = 147,123) and Antillean origin (N = 41,430), in contrast, the association between ethnic density and lower risk remained after each adjustment (P < 0.001). For antidepressants, a negative association with own-group ethnic density was consistently found for those of Antillean origin (OR = 0.62 [0.52-0.74]) only.
These data on dispensing of psychomedication confirm the ethnic density hypothesis for psychosis alongside earlier equivocal findings for other mental disorders. The negative association between own-group ethnic density and dispensing of antipsychotics among the Moroccan- and Turkish-Dutch may be explained, at least in part, by a favourable household composition (i.e., living in a family) in high-density neighborhoods.
居住区域内较高的本族裔密度通常与精神障碍风险降低相关。而对于常见精神障碍，证据则不那么确凿。本研究旨在探究这些发现是否反映在抗精神病药和抗抑郁药的配药数据中。
将所有居住在荷兰四大城市的成年人的医疗保险用药数据与荷兰统计局的人口统计数据相链接。分析 2013 年抗精神病药和抗抑郁药的配药情况与邻里本族裔比例的关系。
在调整了邻里的年龄、性别和社会经济地位后，摩洛哥裔荷兰人（n=115455）的本族裔密度越高，抗精神病药的配药量越低（最高密度五分位数与最低密度五分位数相比的比值[OR]为 0.72[0.66-0.79]）。然而，在调整家庭构成后，这种关联消失了（OR=0.93[0.85-1.03]）。对于土耳其裔荷兰人（n=105460）也发现了类似的结果（OR=0.86[0.76-0.96]和 1.05[0.94-1.18]）。相比之下，对于苏里南裔（n=147123）和安的列斯群岛裔（n=41430），这种种族密度与较低风险之间的关联在每次调整后仍然存在（P<0.001）。对于抗抑郁药，只有安的列斯群岛裔（OR=0.62[0.52-0.74]）与本族裔密度呈负相关。
这些精神药物配药数据证实了种族密度假说对于精神分裂症的适用性，同时也印证了先前对于其他精神障碍的不确定发现。摩洛哥裔和土耳其裔荷兰人之间，本族裔密度与抗精神病药配药量之间的负相关，可能至少部分可以用高密度邻里中有利的家庭构成（即生活在家庭中）来解释。
