Objective:

The authors examined recent trends in incidence of psychotic disorders, demographic characteristics, and comorbid psychiatric and medical conditions among six racial/ethnic groups.

Method:

A retrospective cohort study design was used to examine the incidence of psychotic disorders across race/ethnicity groups and comorbid psychiatric and medical conditions among members of Kaiser Permanente Northern California from 2009 to 2019 (N=5,994,758). Poisson regression was used to assess changes in annual incidence, and Cox proportional hazards and logistic regression models adjusted for age and sex were used to test correlates and consequences.

Results:

Overall, the incidence of nonaffective psychotic disorders decreased slightly over the study period. Compared with White members, the risk of nonaffective psychosis diagnosis was higher among Black (hazard ratio=2.13, 95% CI=2.02–2.24) and American Indian or Alaskan Native (AIAN) (hazard ratio=1.85, 95% CI=1.53–2.23) members and lower among Asian (hazard ratio=0.72, 95% CI=0.68–0.76) and Hispanic (hazard ratio=0.91, 95% CI=0.87–0.96) members, as well as those whose race/ethnicity was categorized as “other” (hazard ratio=0.92, 95% CI=0.86–0.99). Compared with White members, the risk of affective psychosis diagnosis adjusted for age and sex was higher among Black (hazard ratio=1.76, 95% CI=1.62–1.91), Hispanic (hazard ratio=1.09, 95% CI=1.02–1.16), and AIAN (hazard ratio=1.38, 95% CI=1.00–1.90) members and lower among Asian (hazard ratio=0.77, 95% CI=0.71–0.83), Native Hawaiian or other Pacific Islander (hazard ratio=0.69, 95% CI=0.48–0.99), and “other” (hazard ratio=0.86, 95% CI=0.77–0.96) members. Psychotic disorders were associated with significantly higher odds of suicide (odds ratio=2.65, 95% CI=2.15–3.28), premature death (odds ratio=1.30, 95% CI=1.22–1.39), and stroke (odds ratio=1.64, 95% CI=1.55–1.72) and lower odds of health care utilization (odds ratio=0.44, 95% CI=0.42–0.47).

Conclusions:

This study demonstrates racial and ethnic variation in incident psychotic disorder diagnoses in the United States, compared with non-Hispanic Whites. Individuals diagnosed with psychosis face a greater burden of other negative health outcomes and lower odds of health care utilization, reflecting personal and economic impacts. Identifying risk factors for elevated rates and protective influences in subgroups can inform strategies for prevention and interventions to ameliorate severe consequences of psychotic syndromes.

中文翻译：

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种族和民族群体中精神障碍发病率的不平等

客观的：

作者研究了六个种族/族裔群体中精神病发病率、人口特征以及共病精神和医疗状况的最新趋势。

方法：

采用回顾性队列研究设计来检查 2009 年至 2019 年北加州 Kaiser Permanente 成员中跨种族/族裔群体的精神障碍发病率以及共病精神和医疗状况 (N=5,994,758)。泊松回归用于评估年发病率的变化，Cox比例风险和针对年龄和性别调整的逻辑回归模型用于测试相关性和后果。

结果：

总体而言，研究期间非情感性精神病的发生率略有下降。与白人成员相比，黑人（风险比=2.13，95% CI=2.02–2.24）和美洲印第安人或阿拉斯加原住民（AIAN）（风险比=1.85，95% CI=1.53–）被诊断为非情感性精神病的风险更高2.23）成员及更低的亚裔（风险比=0.72，95% CI=0.68–0.76）和西班牙裔（风险比=0.91，95% CI=0.87–0.96）成员，以及种族/族裔被归类为“其他”（风险比=0.92，95% CI=0.86-0.99）。与白人成员相比，经年龄和性别调整后的情感性精神病诊断风险在黑人（风险比=1.76，95% CI=1.62–1.91）、西班牙裔（风险比=1.09，95% CI=1.02–1.16）中更高、AIAN（风险比=1.38，95% CI=1.00–1.90）成员以及亚洲人（风险比=0.77，95% CI=0.71–0.83）、夏威夷原住民或其他太平洋岛民（风险比=0.69、95 % CI=0.48–0.99）和“其他”（风险比=0.86，95% CI=0.77–0.96）成员。精神障碍与自杀（比值比=2.65，95% CI=2.15-3.28）、过早死亡（比值比=1.30，95% CI=1.22-1.39）和中风（比值比=1.64， 95% CI=1.55–1.72）和较低的医疗保健利用率（比值比=0.44，95% CI=0.42–0.47）。

结论：

这项研究表明，与非西班牙裔白人相比，美国精神障碍事件诊断存在种族和民族差异。被诊断患有精神病的个人面临着其他负面健康结果的更大负担，并且利用医疗保健的几率较低，反映了个人和经济影响。确定亚组中发病率升高的危险因素和保护性影响可以为预防和干预策略提供信息，以改善精神病综合征的严重后果。