Abstract
Abstract
Background
Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas.
Methods
We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters.
Results
We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients.
Conclusions
Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.
Funder
U.S. Department of Health & Human Services | NIH | National Institute of Mental Health
Division of Intramural Research, National Institute of Allergy and Infectious Diseases
Publisher
Springer Science and Business Media LLC
Reference65 articles.
1. Jarvis, E. On the supposed increase of insanity. Am. J. Psychiat. 8, 333–364 (1852).
2. Faris, R. E. L., Dunham, H. W. Mental disorders in urban areas: an ecological study of schizophrenia and other psychoses (University of Chicago Press, 1939).
3. Joseph, A. E. & Boeckh, J. L. Locational variation in mental health care utilization dependent upon diagnosis: a Canadian example. Soc. Sci. Med. D Med. Geogr. 15, 395–404 (1981).
4. Packness, A. et al. Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study. Soc. Psychiatry Psychiatr. Epidemiol. 52, 1405–1413 (2017).
5. Stulz, N., Pichler, E.-M., Kawohl, W. & Hepp, U. The gravitational force of mental health services: distance decay effects in a rural Swiss service area. BMC Health Serv. Res. 18, 1–13 (2018).