使用 g 估计法评估非裔美国人为主的队列中感知到的歧视与心理健康之间的未测量混杂关系。

IF 6.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International journal of epidemiology Pub Date : 2024-06-12 DOI:10.1093/ije/dyae085

Jiajun Luo, Loren Saulsberry, William Isaac Krakowka, Habibul Ahsan, Briseis Aschebrook-Kilfoy

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引用次数: 0

摘要

背景：医疗机构中的歧视感会对少数群体的心理健康产生不利影响。然而，感知到的歧视与心理健康之间的关联容易受到未测量混杂因素的影响。本研究旨在利用g估计法定量评估未测量混杂因素对这种关联的影响：方法：在一个以非洲裔美国人为主的队列中，我们采用 g 估计法估算了感知到的歧视与心理健康之间的关联，并对测量到的混杂因素进行了调整和未调整。心理健康通过焦虑症、抑郁症和躁郁症的临床诊断来衡量。感知到的歧视以患者报告的医疗机构中歧视事件的数量来衡量。测量的混杂因素包括人口、社会经济、居住和健康特征。混杂因素的影响用 g 估计中的α1 表示。我们比较了测量混杂因素和未测量混杂因素的α1：结果：在医疗机构中感知到的歧视与心理健康结果之间存在密切联系。就焦虑而言，未经调整的几率比（95% 置信区间）为 1.30（1.21, 1.39），经测量混杂因素调整后为 1.26（1.17, 1.36）。测量混杂因素的α1为-0.066。未测量混杂因素的α1=0.200，是测量混杂因素的三倍多，对应的几率比为 1.12（1.01，1.24）。其他心理健康结果也观察到类似的结果：与测量混杂因素相比，三倍于测量混杂因素的未测量混杂因素不足以解释感知到的歧视与心理健康之间的关联，这表明这种关联不受未测量混杂因素的影响。这项研究为定量评估未测量混杂因素提供了一个新的框架。

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Assessment of unmeasured confounding in the association between perceived discrimination and mental health in a predominantly African American cohort using g-estimation.

Background: Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation.

Methods: In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding.

Results: Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes.

Conclusion: Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.

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来源期刊

International journal of epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

13.60

自引率

2.60%

发文量

226

审稿时长

3 months

期刊介绍： The International Journal of Epidemiology is a vital resource for individuals seeking to stay updated on the latest advancements and emerging trends in the field of epidemiology worldwide. The journal fosters communication among researchers, educators, and practitioners involved in the study, teaching, and application of epidemiology pertaining to both communicable and non-communicable diseases. It also includes research on health services and medical care. Furthermore, the journal presents new methodologies in epidemiology and statistics, catering to professionals working in social and preventive medicine. Published six times a year, the International Journal of Epidemiology provides a comprehensive platform for the analysis of data. Overall, this journal is an indispensable tool for staying informed and connected within the dynamic realm of epidemiology.