种族居住隔离与孕期心理健康。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES
Kendria Kelly-Taylor, Sylvia E Badon, Wendy T Dyer, Alex Asera, Huyun Dong, Tess Baker, Nerissa Nance, Kiarri N Kershaw, Charles P Quesenberry, Kelly C Young-Wolff, Mibhali Bhalala, Kathryn Erickson-Ridout, Lyndsay A Avalos
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引用次数: 0

摘要

重要性研究表明,居住在种族隔离社区的社会、自然和社会经济环境可能会对心理健康产生负面影响:评估亚裔、黑人、西班牙裔和白人的种族居住隔离与产前心理健康之间的关系:这项以人口为基础的横断面研究在综合医疗保健服务系统 Kaiser Permanente Northern California (KPNC) 中进行。参与者包括自我认同的亚裔、黑人、西班牙裔和白人孕妇,他们在 2014 年 1 月 1 日至 2019 年 12 月 31 日期间至少在 KPNC 接受过一次产前检查。数据分析时间为 2023 年 1 月 14 日至 2024 年 8 月 15 日:种族居住隔离度由当地的 Getis-Ord Gi* 统计数据定义,在每个种族和民族群体中计算得出,并归类为低值(1.96)。Gi* 统计量为正值,表明与周围更大的地理区域相比,该种族和族裔群体在指数普查区和邻近普查区的代表性过高(集群或隔离程度更高):产前抑郁症和焦虑症的定义是在最后一次月经第一天至分娩前一天之间的电子健康记录中记录的诊断代码:在纳入分析的 201 115 名参与者(平均 [SD] 年龄为 30.8 [5.3] 岁;26.8% 为亚裔、6.6% 为黑人、28.0% 为西班牙裔和 38.6% 为白人)中,黑人的产前抑郁和焦虑率最高(分别为 18.3% 和 18.4%),其次是白人(分别为 16.0% 和 18.2%)、西班牙裔(分别为 13.0% 和 14.4%)和亚裔(分别为 5.7% 和 6.4%)。亚裔(40.8% 对 31.1%)和黑人(43.3% 对 22.6%)更有可能居住在高隔离度和低隔离度的社区,而西班牙裔居住在高隔离度和低隔离度社区的可能性相同(34.3% 对 34.7%)。与低隔离度相比,高隔离度与黑人产前抑郁(调整后的几率比 [AOR],1.25 [95% CI,1.10-1.42])和焦虑(AOR,1.14 [95% CI,1.00-1.29])的几率更大相关。高度隔离与亚裔(AOR,0.75 [95% CI,0.69-0.82])、西班牙裔(AOR,0.88 [95% CI,0.82-0.94])和白人(AOR,0.91 [95% CI,0.86-0.96])产前抑郁几率较低有关。亚裔(AOR, 0.80 [95% CI, 0.73-0.87])和西班牙裔(AOR, 0.88 [95% CI, 0.82-0.93])与白人(AOR, 0.95 [95% CI, 0.90-1.00])的焦虑程度也有类似关系:在这项横断面研究中,种族和民族居住隔离与黑人的产前心理健康状况较差有关,但与亚裔、西班牙裔和白人的心理健康状况较好有关。减少隔离及其影响的政策可能会改善黑人孕妇的心理健康状况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Racial Residential Segregation and Mental Health During Pregnancy.

Importance: Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health.

Objective: To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals.

Design, setting, and participants: This population-based cross-sectional study was conducted in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. Participants included self-identified Asian, Black, Hispanic, and White pregnant individuals who attended at least 1 prenatal care visit at KPNC between January 1, 2014, and December 31, 2019. Data were analyzed from January 14, 2023, to August 15, 2024.

Exposures: Racial residential segregation, defined by the local Getis-Ord Gi* statistic, was calculated in each racial and ethnic group and categorized as low (<0), medium (0-1.96), or high (>1.96). A positive Gi* statistic indicates overrepresentation (greater clustering or segregation) of the racial and ethnic group in an index census tract and neighboring tracts compared with the larger surrounding geographic area.

Main outcomes and measures: Prenatal depression and anxiety defined by diagnoses codes documented in the electronic health record between the first day of the last menstrual period and the day prior to birth.

Results: Among the 201 115 participants included in the analysis (mean [SD] age, 30.8 [5.3] years; 26.8% Asian, 6.6% Black, 28.0% Hispanic, and 38.6% White), prenatal depression and anxiety were highest in Black individuals (18.3% and 18.4%, respectively), followed by White (16.0% and 18.2%, respectively), Hispanic (13.0% and 14.4%, respectively), and Asian (5.7% and 6.4%, respectively) individuals. Asian (40.8% vs 31.1%) and Black (43.3% vs 22.6%) individuals were more likely to live in neighborhoods with high vs low segregation, while Hispanic individuals were equally likely (34.3% vs 34.7%). High compared with low segregation was associated with greater odds of prenatal depression (adjusted odds ratio [AOR], 1.25 [95% CI, 1.10-1.42]) and anxiety (AOR, 1.14 [95% CI, 1.00-1.29]) among Black individuals. High segregation was associated with lower odds of prenatal depression among Asian (AOR, 0.75 [95% CI, 0.69-0.82]), Hispanic (AOR, 0.88 [95% CI, 0.82-0.94]), and White (AOR, 0.91 [95% CI, 0.86-0.96]) individuals. Similar associations were found for anxiety among Asian (AOR, 0.80 [95% CI, 0.73-0.87]) and Hispanic (AOR, 0.88 [95% CI, 0.82-0.93]) but not White (AOR, 0.95 [95% CI, 0.90-1.00]) individuals.

Conclusions and relevance: In this cross-sectional study, racial and ethnic residential segregation was associated with worse prenatal mental health for Black individuals but better mental health for Asian, Hispanic, and White individuals. Policies reducing segregation and its impact may improve mental health outcomes in pregnant Black individuals.

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来源期刊
CiteScore
4.00
自引率
7.80%
发文量
0
期刊介绍: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health, and health care. The journal publishes original research, evidence-based reports, and opinion about national and global health policy. It covers innovative approaches to health care delivery and health care economics, access, quality, safety, equity, and reform. In addition to publishing articles, JAMA Health Forum also features commentary from health policy leaders on the JAMA Forum. It covers news briefs on major reports released by government agencies, foundations, health policy think tanks, and other policy-focused organizations. JAMA Health Forum is a member of the JAMA Network, which is a consortium of peer-reviewed, general medical and specialty publications. The journal presents curated health policy content from across the JAMA Network, including journals such as JAMA and JAMA Internal Medicine.
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