Department of Public Health Sciences (SC, DY, HTG), University of Rochester School of Medicine and Dentistry, Rochester, NY.
Department of Public Health Sciences, Biological Sciences Division (SW), University of Chicago, Chicago, IL.
Am J Geriatr Psychiatry. 2022 May;30(5):636-646. doi: 10.1016/j.jagp.2021.10.008. Epub 2021 Oct 26.
To examine racial differences in the frequency of schizophrenia diagnosis codes used among nursing home (NH) residents with Alzheimer's Disease and Related Dementias (ADRD), pre and post the implementation of public reporting of antipsychotic use in NHs.
The 2011-2017 Minimum Data Set and Medicare Master Beneficiary Summary File were linked. We identified long-stay NH residents (i.e., those who had quarterly or annual assessments) with ADRD aged 55 years and older (N = 7,734,348). Outcome variable was defined as the diagnosis of schizophrenia documented in the MDS assessments. Main variables of interest included individual race (black versus white), the percent of blacks in a NH and time trend. Multivariate regressions were estimated.
The frequency of schizophrenia diagnosis codes among NH residents with ADRD steadily increased over the study period, and blacks experienced a greater increase than their white counterparts. For example, the overall likelihood of having schizophrenia diagnosis increased 1.9 percentage points (95% confidence interval [CI]: 0.019, 0.020, p < 0.01) from 2011 to 2017 among whites, while blacks had an addition 1.3 percentage points increase (95% CI: 0.011, 0.015, p < 0.01). The increase in the likelihood of having schizophrenia diagnosis code was higher in NHs with higher percent of blacks: the increase from 2011 to 2017 was 2.6 percentage point (95% CI: 0.023, 0.029, p < 0.01) higher in NHs with the highest percent of blacks, compared to NHs with lowest percent of blacks. Racial differences in the growth of schizophrenia diagnosis also existed within a NH after accounting for NH factors.
Following the implementation of public reporting of antipsychotic use in NH, black residents experienced a greater increase in the likelihood of having schizophrenia diagnosis than white NH residents. NHs with a higher proportion of blacks had a greater increase in schizophrenia diagnosis, and blacks experienced an increased likelihood of schizophrenia diagnosis than whites within a NH. Further research is needed to determine a causal relationship between the federal policy mandating public reporting and disparities in schizophrenia diagnostic coding.
研究在实施疗养院（NH）抗精神病药物使用公共报告制度前后，NH 中患有阿尔茨海默病及相关痴呆症（ADRD）的居民中，精神分裂症诊断代码的使用频率在不同种族之间的差异。
将 2011 年至 2017 年最低数据组和医疗保险主受益摘要文件进行了链接。我们确定了患有 ADRD（年龄在 55 岁及以上）且长期居住在 NH 中的居民（即每季度或每年进行评估）（N=7734348）。因变量定义为 MDS 评估中记录的精神分裂症诊断。主要感兴趣的变量包括个体种族（黑人与白人）、NH 中黑人的比例和时间趋势。估计了多变量回归。
在研究期间，NH 中患有 ADRD 的居民中精神分裂症诊断代码的频率稳步上升，黑人的增幅大于白人。例如，2011 年至 2017 年期间，白人的精神分裂症诊断总体可能性增加了 1.9 个百分点（95%置信区间[CI]：0.019，0.020，p<0.01），而黑人则增加了 1.3 个百分点（95%CI：0.011，0.015，p<0.01）。黑人比例较高的 NH 中，增加的幅度更大：与黑人比例最低的 NH 相比，黑人比例最高的 NH 中，从 2011 年到 2017 年，这一可能性增加了 2.6 个百分点（95%CI：0.023，0.029，p<0.01）。在考虑 NH 因素后，NH 内的种族差异也存在于精神分裂症诊断的增长中。
在实施 NH 抗精神病药物使用公共报告制度后，与白人 NH 居民相比，黑人居民精神分裂症诊断的可能性增加幅度更大。黑人比例较高的 NH 中，精神分裂症诊断的增加幅度更大，而 NH 内黑人比白人更有可能被诊断为精神分裂症。需要进一步研究以确定联邦政策要求公共报告与精神分裂症诊断编码差异之间的因果关系。
