背景:在医疗机构中感知到的歧视会对少数群体的心理健康产生不利影响。然而,感知到的歧视和心理健康之间的关联容易产生无法衡量的混淆。该研究旨在定量评估未测量的混杂因素在这种关联中的影响,使用g估计。
方法:在一个以非洲裔美国人为主的群体中,我们应用g估计来估计感知歧视和心理健康之间的关系,对测量的混杂因素进行调整和未调整。心理健康是通过焦虑的临床诊断来衡量的,抑郁症和双相情感障碍。感知到的歧视被测量为医疗保健机构中患者报告的歧视事件的数量。测量的混杂因素包括人口统计,社会经济,居住和健康特征。根据g估计,混杂的影响表示为α1。我们比较了测量和未测量混杂的α1。
结果:观察到卫生保健机构中感知的歧视与心理健康结果之间存在很强的关联。对于焦虑,未对测量的混杂因素进行调整和调整的比值比(95%置信区间)为1.30(1.21,1.39)和1.26(1.17,1.36),分别。测量的混杂的α1为-0.066。未测量的混杂与α1=0.200,这是测量混杂的三倍以上,对应于1.12(1.01,1.24)的赔率比。其他心理健康结果也观察到了类似的结果。
结论:与测量的混杂因素相比,未测量的三倍测量混杂不足以解释感知歧视和心理健康之间的关联,表明这种关联对未测量的混杂是稳健的。这项研究提供了一个新的框架来定量评估未测量的混杂。
BACKGROUND: Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation.
METHODS: In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding.
RESULTS: Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes.
CONCLUSIONS: Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.