Introduction
Methods
Study design and database
Eligibility criteria and study sample
Study measures
Statistical analysis
Results
Descriptive
Variable | Number of visits | Weighted % |
---|---|---|
Age | ||
• 18–44 • 45–64 • 65+ | 477 520 158 | 37.4 48.5 14.1 |
Gender | ||
• Female • Male | 493 662 | 43.7 56.3 |
Race/ethnicity | ||
• White • Black • Hispanic • Asian/Other identies | 700 253 129 73 | 61.8 21.2 11.4 5.6 |
Insurance | ||
• Private • Medicare • Medicaid • Other | 162 465 334 194 | 15.0 39.1 27.0 18.9 |
Psychotic Disorders (% Yes) | ||
• Schizophrenia Dx • Schizoaffective Dx • Unspecified psychosis Dx | 526 415 230 | 44.8 37.4 19.0 |
Co-morbidity (% Yes) | ||
• Lung Dx (Asthma, COPD) • CVD (CVD, Hyperlipidemia) • Depression • Diabetes • Hypertension • Other Co-morbidities* | 79 151 300 124 236 180 | 7.9 13.6 25.6 11.3 23.5 15.2 |
Disposition (% Yes) | ||
• Refer to another physician • Return at specified time/Follow up • Another visit disposition (include ER and Hosp) | 59 1024 117 | 6.3 90.1 8.6 |
Medication Use (% Yes) | ||
• Psychotropic Rx (monotherapy or combination) • Antidepressants • Antipsychotics | 944 456 886 | 82.1 39.4 75.8 |
Variable | Number of Visits | Weight number | Rate (%) |
---|---|---|---|
Age | |||
• 18–44 • 45–64 • 65+ | 477 520 158 | 6,106,822 8,836,434 1,577,997 | 0.89 1.71 0.65 |
Gender | |||
• Female • Male | 493 662 | 7,098,818 9,422,435 | 0.95 1.34 |
Race/ethnicity • White | 700 253 | 10,220,332 3,584,310 | 1.07 2.08 |
• Black • Hispanic • Asian/other | 129 73 | 1,811,621 904,990 | 0.84 0.84 |
Bivariate associations between race/ethnicity and schizophrenia spectrum disorders (SSDs)
Schizophrenia
Schizoaffective diagnosis
Unspecified psychosis disorder
Independent relationship between race/ethnicity and visits for schizophrenia, schizoaffective, and unspecified psychosis disorder
Schizophrenia | ||||||
---|---|---|---|---|---|---|
Total Visits N (%) 526 (44.8) | White Visits n (%) 305 (57.9) | Black Visits n (%) 126 (23.9) | Hispanic Visits n (%) 60 (11.4) | Asian/Others Visits n (%) 35 (6.6) | ||
n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | p-value | |
Age | 0.1123 | |||||
• 18–44 • 45–64 • 65+ | 199 (33.3%) 262 (53.6%) 65 (13.1%) | 106 (34.2%) 163 (53.3%) 36 (12.6%) | 49 (25.1%) 62 (63.3%) 15 (11.7%) | 26 (46.1%) 25 (41.2%) 9 (12.7%) | 18 (44.4%) 12 (28.9%) 5 (26.7%) | |
Gender | 0.9553 | |||||
• Female • Male | 183 (34.9%) 343 (65.2%) | 111 (35.5%) 194 (64.5%) | 38 (32.3%) 88 (67.7%) | 24 (36.2%) 36 (63.8%) | 10 (38.7%) 25 (61.3%) | |
Insurance | 0.0041 | |||||
• Private • Medicare • Medicaid • Other | 57 (10.2%) 204 (37.8%) 177 (32.7%) 88 (19.3%) | 34 (10.9%) 132 (44.1%) 96 (29.7%) 43 (15.2%) | 11 (9.5%) 39 (23.9%) 54 (43.3%) 22 (23.4%) | 6 (11.1%) 20 (36.9%) 21 (29.6%) 13 (22.4%) | 6 (4.8%) 13 (51.0%) 6 (13.3%) 10 (30.9%) | |
Disposition (% Yes) | ||||||
• Refer to another physician • Return at specified time • Other visit disposition | 28 (9.3%) 468 (89.7%) 50 (8.4%) | 18 (4.5%) 272 (90.1%) 29 (10.6%) | 6 (21.2%) 105 (85.0%) 17 (7.2%) | 3 (5.5%) 57 (97.5%) 3 (2.5%) | 1 (0.02%) 34 (95.2%) 1 (4.8%) | < 0.0001 0.0541 0.1572 |
Medication use (% Yes) • Psychotropic Rx (monotherapy or combination) • Antidepressants • Antipsychotics | 413 (75.5%) 166 (29.9%) 398 (72.6%) | 240 (78.6%) 98 (30.9%) 230 (75.7%) | 97 (65.3%) 40 (28.4%) 93 (61.0%) | 46 (79.8%) 22 (37.3%) 46 (61.0%) | 30 (90.9%) 6 (14.3%) 29 (90.5%) | 0.0111 0.2441 0.0026 |
Co-morbidity (% Yes) | ||||||
• Lung, Asthma, COPD • CVD, Hyperlipidemia • Depression • Diabetes • Hypertension • Other Co-morbidities | 37(9.2%) 86 (18.0%) 122 (20.1%) 58 (9.7%) 115 (25.8%) 80 (16.4%) | 25 (9.3%) 49 (14.9%) 78 (19.0%) 26 (6.3%) 57 (20.0%) 44 (13.2%) | 9 (13.2%) 24 (25.5%) 27 (25.4%) 18 (13.3%) 39 (41.3%) 23 (26.3%) | 1 (1.8%) 10 (18.5%) 13 (16.1%) 10 (17.5%) 14 (21.1%) 7 (9.0%) | 2 (1.7%) 3 (7.6%) 4 (11.3%) 4 (8.3%) 5 (10.7%) 6 (10.6%) | 0.0084 0.0839 0.3153 0.0437 0.0006 0.0259 |
Schizoaffective Dx | ||||||
Total Visits N (%) 415 (37.4) | White Visits n (%) 273 (65.7) | Black Visits n (%) 71 (17.1) | Hispanic Visits n (%) 44 (10.6) | Asian/Others Visits n (%) 27 (6.6) | p-value | |
n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | ||
Age | 0.0162 | |||||
• 18–44 • 45–64 • 65+ | 190 (41.0%) 190 (50.3%) 35 (8.6%) | 126 (39.5%) 119 (50.9%) 28 (9.7%) | 30 (39.5%) 40 (59.6%) 1 (0.9%) | 18 (39.6%) 22 (50.6%) 4 (9.8%) | 16 (68.4%) 9 (21.4%) 2 (10.2%) | |
Gender | 0.2372 | |||||
• Female • Mal | 215 (53.5%) 200 (46.5%) | 145 (56.5%) 128 (43.5%) | 37 (44.2%) 34 (55.8%) | 18 (42.7%) 26 (57.3%) | 15 (56.8%) 12 (43.2%) | |
Insurance | 0.0030 | |||||
• Private • Medicare • Medicaid • Other | 58 (15.5%) 179 (43.2%) 115 (22.7%) 63 (18.7%) | 50 (18.9%) 118 (45.2%) 65 (17.1%) 40 (18.8%) | 1 (0.9%) 31 (34.0%) 28 (48.3%) 11 (16.8%) | 4 (8.3%) 17 (42.4%) 14 (32.2%) 9 (17.1%) | 3 (17.5%) 13 (39.0%) 8 (19.3%) 3 (24.1%) | |
Disposition (% Yes) | ||||||
• Refer to another physician • Return at specified time • Other visit disposition | 20 (3.2%) 373 (93.8%) 38 (6.4%) | 14 (3.1%) 243 (94.3%) 26 (5.9%) | 3 (3.3%) 65 (93.0%) 6 (6.3%) | 1 (0.6%) 41 (96.5%) 4 (8.7%) | 2 (9.2%) 24 (83.9%) 2 (9.1%) | 0.1092 0.2026 0.1572 |
Medication (% Yes) | ||||||
• Psychotropic Rx (monotherapy combination) • Antidepressants • Antipsychotics | 373 (92.1%) 206 (50.0%) 351 (85.0%) | 239 (90.3%) 134 (47.3%) 225 (82.5%) | 66 (97.6%) 36 (54.0%) 63 (92.2%) | 42 (97.9%) 21 (56.4%) 38 (90.0%) | 26 (91.6%) 15 (63.6%) 25 (90.9%) | 0.1365 0.4005 0.3635 |
Co-morbidity (% Yes) | ||||||
• Lung, Asthma, COPD) • CVD, Hyperlipidemia • Depression • Diabetes • Hypertension • Other Co-morbidities | 33 (7.6%) 38 (8.5%) 126 (32.1%) 42 (11.4%) 75 (17.8%) 72 (15.1%) | 21 (6.6%) 24 (7.1%) 82 (30.0%) 18 (8.6%) 43 (15.3%) 48 (14.4%) | 5 (8.2%) 5 (8.8%) 22 (39.5%) 12 (16.9%) 17 (28.0%) 11 (15.5%) | 4 (11.5%) 6 (15.1%) 15 (32.8%) 9 (22.4%) 13 (26.6%) 5 (9.4%) | 3 (10.7%) 3 (11.4%) 7 (41.7%) 3 (14.2%) 2 (9.0%) 8 (34.8%) | 0.6616 0.4198 0.6296 0.0626 0.0346 0.0603 |
Unspecified Psychosis Disorder | ||||||
Total Visits N (%) 230 (19.0) | White Visits n (%) 132 (57.3) | Black Visits n (%) 60 (26.0) | Hispanic Visits n (%) 26 (11.3) | Asian/Others Visits n (%) 129 (5.2) | p-value | |
n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | n (weighted %) | ||
Age | 0.1518 | |||||
• 18–44 • 45–64 • 65+ | 94 (38.9%) 75 (34.2%) 61 (26.9%) | 49 (38.0%) 41 (31.6%) 42 (30.4%) | 29 (48.4%) 21 (35.2%) 10 (16.4%) | 11 (37.5%) 8 (29.2%) 7 (33.3%) | 5 (20.9%) 5 (65.9%) 2 (13.1%) | |
Gender | 0.0009 | |||||
• Female • Male | 106 (48.2%) 124 (51.8%) | 72 (56.2%) 60 (43.8%) | 21 (41.9%) 39 (58.1%) | 10 (42.0%) 16 (58.0%) | 3 (5.1%) 9 (94.9%) | |
Insurance | 0.0254 | |||||
• Private • Medicare • Medicaid • Other | 49 (26.4%) 86 (33.1%) 48 (21.5%) 47 (19.0%) | 35 (27.5%) 44 (33.5%) 27 (23.8%) 26 (15.3%) | 6 (13.9%) 30 (38.3%) 12 (17.6%) 12 (30.2%) | 4 (20.3%) 10 (37.6%) 6 (21.1%) 6 (21.0%) | 4 (66.5%) 2 (4.5%) 3 (13.6%) 3 (15.3%) | |
Disposition (% Yes) | ||||||
• Refer to another physician • Return at specified time • Other visit disposition | 12 (5.4%) 197 (83.4%) 30 (13.1%) | 8 (7.2%) 110 (80.5%) 19 (12.2%) | 3 (2.5%) 55 (91.4%) 4 (6.1%) | 1 (4.1%) 23 (83.8%) 3 (26.2%) | 0 (0.0%) 9 (85.5%) 4 (16.8%) | 0.1187 0.2873 0.1278 |
Medication Use (% Yes) | ||||||
• Psychotropic Rx (monotherapy or combination) • Antidepressants • Antipsychotics | 172 (78.2%) 89 (40.3%) 151 (65.9%) | 94 (75.1%) 54 (39.3%) 79 (62.0%) | 47 (78.4%) 19 (39.5%) 45 (73.7%) | 22 (89.8%) 12 (49.1%) 18 (63.4%) | 9 (84.2%) 4 (34.0%) 9 (84.2%) | 0.3153 0.8661 0.3172 |
Co-morbidity (% Yes) | ||||||
• Lung, Asthma, COPD) • CVD, Hyperlipidemia • Depression • Diabetes • Hypertension • Other Co-morbidities | 10 (5.4%) 30 (13.2%) 58 (28.1%) 28 (16.2%) 49 (28.9%) 30 (12.1%) | 7 (6.6%) 19 (14.1%) 35 (27.7%) 17 (20.4%) 28 (28.8%) 15 (12.2%) | 2 (4.7%) 7 (9.0%) 12 (26.5%) 6 (14.8%) 11 (15.9%) 11 (17.0%) | 1 (3.4%) 3 (21.0%) 9 (36.1%) 3 (4.8%) 7 (32.3%) 2 (6.9%) | 0 (0.0%) 1 (2.3%) 2 (20.1%) 2 (4.5%) 3 (62.8%) 2 (7.4%) | 0.5026 0.4295 0.8596 0.0291 0.1283 0.6943 |
Outcome | Model 1 outcome Schizophrenia (N = 526) | Model 2 outcome Schizoaffective (N = 415) | Model 3 outcome Unspecified psychosis disorder (N = 230) | |||
---|---|---|---|---|---|---|
Variable | AOD (95% CI) | p-value | AOD (95% CI) | p-value | AOD (95% CI) | p-value |
Age | ||||||
• 18–44 (Ref) | ||||||
• 45–64 | 1.52 (1.16–1.97) | 0.0020 | 0.90 (0.68–1.20) | 0.4875 | 0.60 (0.40–0.88) | 0.0093 |
• 65+ | 1.34 (0.67–2.67) | 0.4077 | 0.29 (0.15–0.56) | 0.0002 | 2.44 (1.34–4.44) | 0.0035 |
Gender | ||||||
• Female (Ref) | ||||||
• Male | 1.81 (1.31–2.51) | 0.0003 | 0.52 (0.39–0.69) | < 0.0001 | 0.87 (0.59–1.26) | 0.4537 |
Race/ethnicity | ||||||
• White (Ref) | ||||||
• Black | 1.94 (1.28–2.95) | 0.0019 | 0.42 (0.26–0.68) | 0.0003 | 1.18 (0.65–2.16) | 0.5889 |
• Hispanic | 1.20 (0.77–1.87) | 0.4317 | 0.74 (0.46–1.18) | 0.2022 | 1.27 (0.76–2.13) | 0.3559 |
• Asian/other | 1.34 (0.85–2.13) | 0.2097 | 0.68 (0.32–1.46) | 0.3247 | 1.11 (0.49–2.53) | 0.8004 |
Insurance | ||||||
• Private (Ref) | ||||||
• Medicare | 1.93 (1.19–3.14) | 0.0080 | 1.30 (0.75–2.25) | 0.3449 | 0.24 (0.13–0.43) | < 0.0001 |
• Medicaid | 2.62 (1.53–4.48) | 0.0005 | 0.82 (0.45–1.47) | 0.4974 | 0.31 (0.17–0.55) | <0.0001 |
• Other | 1.61 (0.90–2.86) | 0.1064 | 1.18 (0.61–2.30) | 0.6219 | 0.39 (0.20–0.75) | 0.0047 |
Disposition | ||||||
• Refer to another physician | ||||||
-No (Ref) | ||||||
-Yes | 3.28 (1.81–5.93) | <0.0001 | 0.53 (0.29–0.97) | 0.0379 | 0.35 (0.14–0.89) | 0.0268 |
• Return at specified time | ||||||
-No (Ref) | ||||||
-Yes | 1.47 (0.77–2.79) | 0.2464 | 1.64 (0.82–3.25) | 0.1601 | 0.24 (0.09–0.61) | 0.0030 |
• Other visit disposition | ||||||
-No (Ref) | ||||||
-Yes | 1.19 (0.56–2.50) | 0.6535 | 1.09 (0.57–2.10) | 0.7934 | 0.49 (0.18–1.31) | 0.1524 |
Medication use | ||||||
• Psychotropic Rx (monotherapy or combination) | ||||||
-No (Ref) | ||||||
-Yes | 0.22 (0.10–0.49) | 0.0002 | 2.62 (0.99–6.94) | 0.0526 | 1.88 (0.81–4.36) | 0.1412 |
• Antidepressants | ||||||
-No (Ref) | ||||||
-Yes | 0.59 (0.41–0.85) | 0.0046 | 1.43 (0.99–2.06) | 0.0586 | 1.20 (0.76–1.90) | 0.4329 |
• Antipsychotics | ||||||
-No (Ref) | ||||||
-Yes | 2.71 (1.46–5.06) | 0.0017 | 1.13 (0.57–2.27) | 0.7236 | 0.33 (0.18–0.63) | 0.0007 |
Co-morbidity | ||||||
• Lung, Asthma, COPD | ||||||
-No (Ref) | ||||||
-Yes | 1.66 (0.98–2.80) | 0.0576 | 0.90 (0.57–1.43) | 0.6565 | 0.53 (0.29–0.99) | 0.0463 |
• CVD, Hyperlipidemia | ||||||
-No (Ref) | ||||||
-Yes | 2.68 (1.62–4.45) | 0.0001 | 0.44 (0.27–0.72) | 0.0011 | 0.65 (0.37–1.14) | 0.1299 |
• Depression | ||||||
-No (Ref) | ||||||
-Yes | 0.60 (0.37–0.97) | 0.0385 | 1.81 (1.07–3.04) | 0.0261 | 0.96 (0.58–1.58) | 0.8714 |
• Diabetes | ||||||
-No (Ref) | ||||||
-Yes | 0.50 (0.31–0.81) | 0.0051 | 1.32 (0.74–2.35) | 0.3540 | 2.20 (1.15–4.22) | 0.0176 |
• Hypertension | ||||||
-No (Ref) | ||||||
-Yes | 0.83 (0.59–1.16) | 0.2775 | 0.89 (0.61–1.30) | 0.5533 | 1.42 (0.91–2.22) | 0.1179 |
• Other co-morbidities | ||||||
-No (Ref) | ||||||
-Yes | 1.09 (0.75–1.59) | 0.6578 | 1.15 (0.77–1.72) | 0.5079 | 0.66 (0.36–1.21) | 0.1800 |