Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
J Racial Ethn Health Disparities. 2021 Feb;8(1):220-229. doi: 10.1007/s40615-020-00774-y. Epub 2020 May 30.
To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression.
This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk.
The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings.
Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.
评估与产后抑郁症相关的住院治疗在不同种族和族裔人群中的差异。
这是一项使用加利福尼亚州全州规划与发展办公室数据中采用国际疾病分类，第九修订版，临床修正（ICD-9-CM）诊断代码的回顾性队列研究。我们纳入了 2008 年至 2012 年期间行分娩住院治疗的初产妇。主要结局是产后 9 个月内首次因抑郁症使用 ICD-9-CM 代码进行的产后住院就诊。我们根据种族/族裔检查了产后抑郁症住院治疗的累积发生率。使用逻辑回归估计相对风险。
研究队列包括 984167 名初产妇：314037 名（32%）为非西班牙裔白人；59754 名（6%）为非西班牙裔黑人；150855 名（15%）为非西班牙裔亚裔；448770 名（46%）为西班牙裔；10399 名（1%）为其他种族。黑人女性（39；95%CI=34-44/10000 分娩）的产后抑郁症住院治疗累积发生率最高，而亚裔女性（7；95%CI=5-8/10000 分娩）最低。与白人女性相比，黑人女性更有可能接受产后抑郁症的住院治疗（OR=2.3；95%CI=1.9-2.7），而亚洲女性（OR=0.4；95%CI=0.3-0.5）和西班牙裔女性（OR=0.8；95%CI=0.7-1.0）接受治疗的可能性较小。在排除产前抑郁症女性、调整社会人口学和临床变量以及根据护理环境分层后，观察到了类似的结果。
与白人女性相比，黑人女性更频繁地受到产后抑郁症住院治疗的影响。确定并改善产后妇女获得和利用精神保健服务方面的不平等现象，应成为产妇保健的重点。
