Socioeconomic and geographic disparities in psychiatric outcomes under Colombia's universal healthcare system.

BACKGROUND

Despite growing healthcare coverage, disparities in access to and outcomes of psychiatric care persist, even in countries with universal healthcare. How socioeconomic status (SES), travel time, and social support individually and jointly affect psychiatric clinical trajectories remains largely unexplored.

METHODS

We analyze electronic health records (EHRs) from patients diagnosed with bipolar disorder, major depressive disorder, or schizophrenia at Clínica San Juan de Dios Manizales. Using zero-inflated and standard negative binomial regression, we quantify the effects of SES, travel time, and family/social support on utilization, clinical outcomes, and symptoms of mania, psychosis, and suicidality. A mixed-effects model examines how care-seeking patterns affect visit-to-visit variability in outcomes.

RESULTS

Among 21,095 patients, utilization is lower for those with low SES (rate ratio [RR] 0.92, 95% CI: 0.90-0.95, p = 1.27e-10) and longer travel times (RR 0.94, 95% CI: 0.93-0.95, p = 1.19e-53). Patients with low SES are more likely to have severe symptoms (e.g., delusions: RR 1.28, 95% CI: 1.20-1.37, p = 2.57e-15) and require hospitalization (RR 1.10, 95% CI: 1.05-1.15, p = 1.94e-04), suggesting they primarily seek care when critical. Longer travel differentially affects those with low SES. However, the relationship between SES and adverse outcomes is less pronounced when living with family (e.g., hospitalizations: LRT, χ2 = 47.08, df = 3, p = 3.35e-10). Frequent outpatient care is associated with lower odds of hospitalization, suicidality, and other symptoms.

CONCLUSIONS

Findings demonstrate use of EHRs to model patient outcomes, the important role of social support, and need for improved healthcare accessibility.