Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders
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)...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2024-02-01
|
| Series: | Communications Medicine |
| Online Access: | https://doi.org/10.1038/s43856-024-00441-x |
| _version_ | 1797273491977797632 |
|---|---|
| author | Janet Song Mauricio Castaño Ramírez Justin T. Okano Susan K. Service Juan de la Hoz Ana M. Díaz-Zuluaga Cristian Vargas Upegui Cristian Gallago Alejandro Arias Alexandra Valderrama Sánchez Terri Teshiba Chiara Sabatti Ruben C. Gur Carrie E. Bearden Javier I. Escobar Victor I. Reus Carlos Lopez Jaramillo Nelson B. Freimer Loes M. Olde Loohuis Sally Blower |
| author_facet | Janet Song Mauricio Castaño Ramírez Justin T. Okano Susan K. Service Juan de la Hoz Ana M. Díaz-Zuluaga Cristian Vargas Upegui Cristian Gallago Alejandro Arias Alexandra Valderrama Sánchez Terri Teshiba Chiara Sabatti Ruben C. Gur Carrie E. Bearden Javier I. Escobar Victor I. Reus Carlos Lopez Jaramillo Nelson B. Freimer Loes M. Olde Loohuis Sally Blower |
| author_sort | Janet Song |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T14:45:08Z |
| format | Article |
| id | doaj.art-d255590d65724b408527f29d6bb27b2d |
| institution | Directory Open Access Journal |
| issn | 2730-664X |
| language | English |
| last_indexed | 2024-03-07T14:45:08Z |
| publishDate | 2024-02-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Communications Medicine |
| spelling | doaj.art-d255590d65724b408527f29d6bb27b2d2024-03-05T20:05:35ZengNature PortfolioCommunications Medicine2730-664X2024-02-01411910.1038/s43856-024-00441-xGeospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disordersJanet Song0Mauricio Castaño Ramírez1Justin T. Okano2Susan K. Service3Juan de la Hoz4Ana M. Díaz-Zuluaga5Cristian Vargas Upegui6Cristian Gallago7Alejandro Arias8Alexandra Valderrama Sánchez9Terri Teshiba10Chiara Sabatti11Ruben C. Gur12Carrie E. Bearden13Javier I. Escobar14Victor I. Reus15Carlos Lopez Jaramillo16Nelson B. Freimer17Loes M. Olde Loohuis18Sally Blower19Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesDepartment of Mental Health and Human Behavior, University of CaldasCenter for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of CaliforniaCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesDepartment of Psychiatry, University of AntioquíaDepartment of Mental Health and Human Behavior, University of CaldasDepartment of Psychiatry, University of AntioquíaDepartment of Mental Health and Human Behavior, University of CaldasCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesDepartment of Biomedical Data Science, Stanford UniversityDepartment of Psychiatry, University of Pennsylvania School of Medicine and the Penn-CHOP Lifespan Brain InstituteCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesDepartment of Psychiatry, Herbert Wertheim College of Medicine, Florida International UniversityDepartment of Psychiatry, University of California San FranciscoDepartment of Psychiatry, University of AntioquíaCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesCenter for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los AngelesCenter for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of CaliforniaAbstract 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.https://doi.org/10.1038/s43856-024-00441-x |
| spellingShingle | Janet Song Mauricio Castaño Ramírez Justin T. Okano Susan K. Service Juan de la Hoz Ana M. Díaz-Zuluaga Cristian Vargas Upegui Cristian Gallago Alejandro Arias Alexandra Valderrama Sánchez Terri Teshiba Chiara Sabatti Ruben C. Gur Carrie E. Bearden Javier I. Escobar Victor I. Reus Carlos Lopez Jaramillo Nelson B. Freimer Loes M. Olde Loohuis Sally Blower Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders Communications Medicine |
| title | Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders |
| title_full | Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders |
| title_fullStr | Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders |
| title_full_unstemmed | Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders |
| title_short | Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders |
| title_sort | geospatial investigations in colombia reveal variations in the distribution of mood and psychotic disorders |
| url | https://doi.org/10.1038/s43856-024-00441-x |
| work_keys_str_mv | AT janetsong geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT mauriciocastanoramirez geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT justintokano geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT susankservice geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT juandelahoz geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT anamdiazzuluaga geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT cristianvargasupegui geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT cristiangallago geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT alejandroarias geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT alexandravalderramasanchez geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT territeshiba geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT chiarasabatti geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT rubencgur geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT carrieebearden geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT javieriescobar geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT victorireus geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT carloslopezjaramillo geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT nelsonbfreimer geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT loesmoldeloohuis geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders AT sallyblower geospatialinvestigationsincolombiarevealvariationsinthedistributionofmoodandpsychoticdisorders |