背景:基于人群的调查表明,较低的社会经济地位(SES)与较高的抑郁症状患病率有关,而他们的医疗保健利用率不一定更高。
目的:调查社区社会经济状况(NSES)与被诊断为重度抑郁症(MDD)的个体的医疗保健利用之间的关系。
方法:这是一项回顾性纵向研究,对2010-2018年期间在初级保健中首次诊断为MDD的所有成年人进行了研究。NSES使用Mosaic™分类由居住的家庭区域定义。结果是AD(抗抑郁药)(N06A)分配和精神病门诊就诊,这两种方法都被列为抑郁症指南中的选项。Cox多变量回归用于事件时间分析。
结果:共纳入117,193人,其中87,499(75%)被分配了AD和35,989(31%)的精神病门诊就诊记录。与高NSES相比,低NSES与诊断后第一年AD分配率较低(HR:0.95,95%CI:0.93-0.96,p<0.001)和精神病就诊率较高(HR:1.10,95%CI:1.07-1.12,p<0.001)相关。
结论:数据源具有很高的覆盖率。不包括由非公共资助的提供者提供的少数精神病护理。无法调整抑郁症的严重程度。
结论:按居住区衡量的社会经济状况与MDD中的AD分配和精神病门诊就诊有关,也在几乎免费访问的医疗保健系统中。这与临床实践有关,考虑到对护理公平性的关注和全球抑郁症患病率的增加。
BACKGROUND: Population-based surveys suggest that low socioeconomic status (SES) is associated with higher prevalence of depressive symptoms, while their healthcare utilization is not necessarily higher.
OBJECTIVE: To investigate the association between neighborhood socioeconomic status (NSES) and healthcare utilization among individuals diagnosed with major depressive disorder (MDD).
METHODS: This was a retrospective longitudinal study of all adults with a first MDD diagnosis within primary care during 2010-2018. NSES was defined by the household area of residence using the Mosaic™ classification. Outcomes were AD (antidepressants) (N06A) dispensation and psychiatric outpatient visit, both of which are outlined as options in depression guidelines. Cox multivariable regression was used for the time to event analyses.
RESULTS: A total of 117,193 individuals were included, of which 87,499 (75 %) were dispensed an AD and 35,989 (31 %) had a recorded psychiatric outpatient visit. Low NSES was associated with lower rate of AD dispensation in the first-year post-diagnosis (HR: 0.95, 95 % CI: 0.93-0.96, p < 0.001) and higher rate of psychiatric visit (HR: 1.10, 95 % CI: 1.07-1.12, p < 0.001) compared with high NSES.
CONCLUSIONS: Data sources have high coverage. A minority of psychiatric care provided by non-publicly financed providers was not included. It was not possible to adjust for depression severity.
CONCLUSIONS: Socioeconomic status as measured by the neighborhood of residency was associated with AD dispensation and psychiatric outpatient visit in MDD, also in a healthcare system with virtually free access. This is of relevance for clinical practice, considering the focus on equity of care and the increase in depression prevalence worldwide.