Department of Public Health Sciences, Penn State University College of Medicine, Hersey, PA, USA.
Department of Psychiatry and Behavioral Health Hershey, Penn State University College of Medicine, Hersey, PA, USA.
Bipolar Disord. 2022 Feb;24(1):48-58. doi: 10.1111/bdi.13082. Epub 2021 Apr 30.
To examine gender disparities in the diagnosis of bipolar disorder (BD) within a privately insured population in the United States and investigate potential contributing factors for these gender differences.
This retrospective cohort study utilized 2005-2017 claims data from the MarketScan Commercial Claims and Encounters database. The study cohort included subjects, aged 10-64 years, who had a minimum of 1-year continuous insurance coverage and no record of a BD diagnosis before cohort entry. We examined the gender difference in BD diagnosis rate, overall and by subgroups. We then used Cox regression models to evaluate the gender effect on time to first BD diagnosis, and the potential moderators of gender effect.
The study cohort consisted of 97,193,443 subjects; 0.45% of subjects were diagnosed with BDs after cohort entry with males having a lower diagnosis rate than females (0.36% vs. 0.54%). The Cox regression analysis indicated that males were less likely to be diagnosed with BDs (unadjusted Hazard Ratio, HR [95% CI]: 0.69 [0.68-0.69]) and gender difference remained significant after adjusting for demographics, comorbidity and healthcare utilizations (adjusted HR [95% CI]: 0.77 [0.76-0.77]). Gender disparity was consistently strong among most age groups, but varied in other demographic subgroups.
Even though the prevalence of BDs is approximately equal between genders in the general population, our study found a much lower diagnosis rate in men compared to women for a privately insured U.S.
Future studies aimed at identifying and understanding the barriers to diagnosis of BDs in men are warranted.
在美国私人保险人群中，考察双相情感障碍（BD）诊断中的性别差异，并研究这些性别差异的潜在促成因素。
本回顾性队列研究利用了 2005-2017 年 MarketScan 商业索赔和遭遇数据库中的索赔数据。研究队列包括年龄在 10-64 岁之间的患者，这些患者至少有 1 年的连续保险覆盖，且在队列入组前无 BD 诊断记录。我们检查了 BD 诊断率的性别差异，包括总体情况和亚组情况。然后，我们使用 Cox 回归模型评估性别对首次 BD 诊断时间的影响，以及性别影响的潜在调节因素。
研究队列包括 97193443 名患者；有 0.45%的患者在入组后被诊断为 BD，男性的诊断率低于女性（0.36%比 0.54%）。Cox 回归分析表明，男性被诊断为 BD 的可能性较低（未调整的风险比[95%CI]：0.69[0.68-0.69]），并且在调整了人口统计学、合并症和医疗保健利用情况后，性别差异仍然显著（调整后的风险比[95%CI]：0.77[0.76-0.77]）。在大多数年龄组中，性别差异一直很强，但在其他人口统计学亚组中则有所不同。
尽管一般人群中 BD 的患病率在性别之间大致相等，但我们的研究发现，在美国私人保险人群中，男性的诊断率明显低于女性。未来的研究旨在确定和理解男性 BD 诊断障碍是必要的。
