背景:围产期情绪和焦虑障碍很常见,怀孕的严重并发症。在这些疾病的患病率和治疗方面,种族和收入存在差异,总体治疗率仍然很低。怀孕之外,少量文献表明,农村居民可能会导致那些被认定为女性的人患抑郁症的比例更高。然而,在更多样化的人群中,有证据表明,城市居住权可能与有色人种女性的抑郁症发病率较高有关。目前尚不清楚这些趋势是否适用于怀孕和产后的情绪和焦虑症。
目的:我们研究了农村居民和城市居民在围产期情绪障碍和焦虑障碍检测和治疗方面的差异,并评估了所观察到的差异是否因母亲种族或民族而异。
方法:我们使用2016年至2020年俄勒冈州和南卡罗来纳州的关联医疗补助索赔和出生证明记录进行了一项横断面研究。我们使用国际疾病分类第10版代码确定了围产期(怀孕和产后60天内)的围产期情绪和焦虑症诊断,并使用Medicaid索赔列举了接受药物治疗和心理治疗的情况。我们使用逻辑回归模型来控制相关的临床和社会人口统计学特征,以估计农村居民与情绪障碍检测和治疗之间的关联。
结果:在我们的样本中,有185,809个新生儿,农村地区的人口占27%(n=50,820),城市地区的人口占73%(n=134,989)。任何围产期情绪障碍和焦虑障碍诊断的患病率,城市居民(19.5%)高于农村居民(18.0%;P<.001)。围产期情绪障碍和焦虑症患者的总体治疗率较低(42%[n=14,789])。在我们调整后的模型中,那些生活在城市地区的人患围产期情绪和焦虑症的几率更高(调整后的优势比,1.059[95%置信区间,1.059-1.059],P<.001)。我们发现母亲种族和农村之间存在显著的相互作用(P<.001)。当我们按种族分层时,我们发现在那些被认定为黑人的人中,城市居民的围产期情绪和焦虑症诊断的几率增加(赔率比,1.188[95%置信区间,1.188-1.188]),而在那些被认定为白人的人中,没有这样增加的赔率(赔率比,1.027[95%置信区间,0.843-1.252]).
结论:我们发现农村居民和城市居民在围产期情绪和焦虑症诊断率方面存在微小但有意义的差异。我们检测到种族与农村和城市产妇居住之间的相互作用,影响了观察到的差异。通过阐明种族和其他社会人口因素之间的交集,我们希望能够在最需要的社区进行更有针对性和有意义的投资。
BACKGROUND: Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.
OBJECTIVE: We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.
METHODS: We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.
RESULTS: Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P<.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059-1.059], P<.001). We found a significant interaction between maternal race and rurality (P<.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188-1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843-1.252]).
CONCLUSIONS: We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection between race and other sociodemographic factors, we hope more targeted and meaningful investments can be made in the communities most in need.