Exploring racial disparity in posttraumatic stress disorder diagnosis: implications for care of African American women.
OBJECTIVE
To explore factors contributing to disparities in posttraumatic stress disorder (PTSD) diagnosis between African Americans and White Americans, while controlling for gender and class by using a data set limited to poor women.


METHODS
A cross-sectional epidemiological secondary analysis.


METHODS
Michigan Medicaid fee-for-service claims data from 1994 through 1997.


METHODS
A total of 20,298 African American and White American adolescents and adult women, including 2,996 with PTSD diagnosis.


METHODS
Victimization, PTSD diagnosis, psychiatric and somatic comorbidities, and PTSD treatment.


RESULTS
African American women were under-represented in the group diagnosed with PTSD (12% versus 31% in the comparison group), despite having equal rates of hospitalization for rape and battering. They were less likely to be diagnosed with comorbidities associated with complex PTSD, such as dissociative disorder (OR = 0.259, p < .001) or borderline personality disorder (OR = 0.178, p < .001), but were equally likely to be diagnosed with conduct disorder, schizophrenia, or substance abuse. African American women were 40% less likely to have continuous insurance coverage.


CONCLUSIONS
Patient, provider, and system factors appear to interact to create disparities in PTSD diagnosis and treatment. Attention to case finding and provider or system bias may help reduce disparities.
Seng
Julia S
JS
University of Michigan, Institute for Research on Women and Gender, 6120 Lane Hall, 204 S. State Street, Ann Arbor, MI 48109-1290, USA. jseng@umich.edu
Kohn-Wood
Laura P
LP
Odera
Lilian A
LA
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008403:Mass Screening; D008484:Medicaid / Q000706:statistics & numerical data; D008824:Michigan / Q000453:epidemiology; D015999:Multivariate Analysis; D024802:Nurse's Role; D011787:Quality of Health Care; D011902:Rape / Q000706:statistics & numerical data; D013179:Spouse Abuse / Q000208:ethnology / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data; D014930:Women / Q000523:psychology