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
{"title":"种族居住隔离与孕期心理健康。","authors":"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","doi":"10.1001/jamahealthforum.2024.3669","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health.</p><p><strong>Objective: </strong>To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposures: </strong>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.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions and relevance: </strong>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.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":null,"pages":null},"PeriodicalIF":9.5000,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Racial Residential Segregation and Mental Health During Pregnancy.\",\"authors\":\"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\",\"doi\":\"10.1001/jamahealthforum.2024.3669\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health.</p><p><strong>Objective: </strong>To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposures: </strong>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.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions and relevance: </strong>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.</p>\",\"PeriodicalId\":53180,\"journal\":{\"name\":\"JAMA Health Forum\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2024-10-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA Health Forum\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1001/jamahealthforum.2024.3669\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Health Forum","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1001/jamahealthforum.2024.3669","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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.
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.