Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions
Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions
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DOI：
10.1186/s12889-019-6526-6
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发表时间：
2019-02-26
影响因子：
4.5
通讯作者：
Prieto, Diana
中科院分区：
文献类型：
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作者：
Martinez, Diego A.;Zhang, Haoxiang;Prieto, Diana
背景大多数关于全民医疗保健等候名单的死亡率和预后因素的数据来自北美、澳大利亚和欧洲，来自南美洲的信息很少。我们的目的是确定智利特定医疗中心的等待时间与等待名单死亡率之间的关系。方法使用 2008 年至 2015 年智利三个地理遥远地区的非优先健康问题医疗专家候补名单中列出的所有新患者的数据，我们构建了分层多变量生存模型来预测每个医疗中心注册后两年的死亡风险。采用Kendall等级相关分析来衡量医疗中心特定死亡风险比与等待时间之间的关联。结果77个医疗中心共有987,497名患者等待护理，其中33,546名患者（3.40%）在登记后两年内死亡。男性（风险比 [HR]=1.17，95% 置信区间 [CI] 1.1-1.24）、年龄较大（HR=2.88，95% CI 2.72-3.05）、城市居住（HR=1.19，95% CI 1.09-1.31）、三级医疗（HR=2.2，95% CI 1.09-1.31） 2.14-2.26）、肿瘤学（HR=3.57，95% CI 3.4-3.76）和血液学（HR=1.6，95% CI 1.49-1.73）与每个医疗中心的较高死亡风险相关，但地区间差异较大。等待时间变异性与死亡之间存在统计学上显着的关联（Z=2.16，P=0.0308）。 结论 在智利医院，非优先健康状况的患者等待时间与死亡率增加相关。
BackgroundMost data on mortality and prognostic factors of universal healthcare waiting lists come from North America, Australasia, and Europe, with little information from South America. We aimed to determine the relationship between medical center-specific waiting time and waiting list mortality in Chile.MethodUsing data from all new patients listed in medical specialist waitlists for non-prioritized health problems from 2008 to 2015 in three geographically distant regions of Chile, we constructed hierarchical multivariate survival models to predict mortality risk at two years after registration for each medical center. Kendall rank correlation analysis was used to measure the association between medical center-specific mortality hazard ratio and waiting times.ResultThere were 987,497 patients waiting for care at 77 medical centers, including 33,546 (3.40%) who died within two years after registration. Male gender (hazard ratio [HR]=1.17, 95% confidence interval [CI] 1.1-1.24), older age (HR=2.88, 95% CI 2.72-3.05), urban residence (HR=1.19, 95% CI 1.09-1.31), tertiary care (HR=2.2, 95% CI 2.14-2.26), oncology (HR=3.57, 95% CI 3.4-3.76), and hematology (HR=1.6, 95% CI 1.49-1.73) were associated with higher risk of mortality at each medical center with large region-to-region variations. There was a statistically significant association between waiting time variability and death (Z=2.16, P=0.0308).ConclusionPatient wait time for non-prioritized health conditions was associated with increased mortality in Chilean hospitals.