ImportanceStudies suggest a higher risk of schizophrenia diagnoses in Black vs White Americans, yet a systematic investigation of disparities that include other ethnoracial groups and multiple outcomes on the psychosis continuum is lacking.ObjectiveTo identify ethnoracial risk variation in the US across 3 psychosis continuum outcomes (ie, schizophrenia and other psychotic disorders, clinical high risk for psychosis [CHR-P], and psychotic symptoms [PSs] and psychotic experiences [PEs]).Data SourcesPubMed, PsycINFO and Embase were searched up to December 2022.Study SelectionObservational studies on ethnoracial differences in risk of 3 psychosis outcomes.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Using a random-effects model, estimates for ethnoracial differences in schizophrenia and PSs/PEs were pooled and moderation by sampling and setting was determined, along with the assessment of heterogeneity and risk of bias.Main Outcomes and MeasuresRisk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs.ResultsOf 64 studies in the systematic review, 47 were included in the meta-analysis comprising 54 929 people with schizophrenia and 223 097 with data on PSs/PEs. Compared with White individuals, Black individuals had increased risk of schizophrenia (pooled odds ratio [OR], 2.07; 95% CI, 1.64-2.61) and PSs/PEs (pooled standardized mean difference [SMD], 0.10; 95% CI, 0.03-0.16), Latinx individuals had higher risk of PSs/PEs (pooled SMD, 0.15; 95% CI, 0.08-0.22), and individuals classified as other ethnoracial group were at significantly higher risk of schizophrenia than White individuals (pooled OR, 1.81; 95% CI, 1.31-2.50). The results regarding CHR-P studies were mixed and inconsistent. Sensitivity analyses showed elevated odds of schizophrenia in Asian individuals in inpatient settings (pooled OR, 1.84; 95% CI, 1.19-2.84) and increased risk of PEs among Asian compared with White individuals, specifically in college samples (pooled SMD, 0.16; 95% CI, 0.02-0.29). Heterogeneity across studies was high, and there was substantial risk of bias in most studies.Conclusions and RelevanceFindings of this systematic review and meta-analysis revealed widespread ethnoracial risk variation across multiple psychosis outcomes. In addition to diagnostic, measurement, and hospital bias, systemic influences such as structural racism should be considered as drivers of ethnoracial disparities in outcomes across the psychosis continuum in the US.

中文翻译：

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美国精神病连续体的种族风险变化

重要性研究表明，美国黑人与白人之间的精神分裂症诊断风险较高，但缺乏对包括其他种族群体和精神病连续体的多种结果在内的差异的系统调查。 目的确定美国在 3 种精神病连续体结果（即、精神分裂症和其他精神病、精神病临床高风险 [CHR-P]、精神病症状 [PSs] 和精神病经历 [PEs]）。数据来源 PubMed、PsycINFO 和 Embase 检索截至 2022 年 12 月。研究选择关于民族种族的观察性研究3 种精神病结果的风险存在差异。数据提取和合成遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。使用随机效应模型，汇总了精神分裂症和 PSs/PE 的种族差异估计，并确定了抽样和设置的调节，以及异质性和偏倚风险的评估。主要结果和措施精神分裂症和其他精神障碍的风险， CHR-P，以及 CHR-P 和 PSs/PE 之间向精神病的转变。结果 在系统评价的 64 项研究中，47 项纳入荟萃分析，其中包括 54 929 名精神分裂症患者和 223 097 名有 PSs/PE 数据的患者。与白人相比，黑人患精神分裂症的风险增加（汇总比值比 [OR]，2.07；95% CI，1.64-2.61）和 PSs/PE（汇总标准化平均差 [S​​MD]，0.10；95% CI，0.03） -0.16），拉丁裔个体患 PSs/PE 的风险较高（汇总 SMD，0.15；95% CI，0.08-0.22），而被归类为其他种族群体的个体患精神分裂症的风险显着高于白人个体（汇总 OR，1.81） ；95% CI，1.31-2.50）。CHR-P 研究的结果好坏参半且不一致。敏感性分析显示，与白人相比，亚洲人在住院环境中患精神分裂症的几率更高（汇总 OR，1.84；95% CI，1.19-2.84），并且亚洲人患 PE 的风险更高，特别是在大学样本中（汇总 SMD，0.16；95） % CI，0.02-0.29）。研究之间的异质性很高，大多数研究都存在很大的偏倚风险。结论和相关性本次系统评价和荟萃分析的结果显示，多种精神病结果之间存在广泛的种族风险差异。除了诊断、测量和医院偏见之外，结构性种族主义等系统性影响也应被视为美国精神病连续体结果中种族差异的驱动因素。