Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort
Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort
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DOI：
10.1136/bmjopen-2019-031251
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发表时间：
2019-12-01
期刊：
影响因子：
2.9
通讯作者：
Khaw, Kay-Tee
中科院分区：
文献类型：
--
作者：
Luben, Robert;Hayat, Shabina;Khaw, Kay-Tee
目的探讨居住区贫困指数是否能预测随后的住院率和住院时间，而不受个人社会阶层和生活方式因素的影响。设计前瞻性人群研究。参与者为一般人群中的11214名男性和13763名女性，招募时年龄为40-79岁主要观察指标：19年期间住院总人数和住院时间结果与居住汤森地区贫困指数低于英格兰和威尔士平均水平的人相比，那些剥夺指数高于平均水平的人有更高的可能性在医院度过>20天，多变量调整OR 1.18（95%CI 1.07 - 1.29）和有7次或以上入院OR 1.11（95%CI 1.02 - 1.22），调整年龄、性别、吸烟状况、教育、社会阶层和体重指数后。职业社会阶层和教育程度改变了区域剥夺与住院之间的关系;社会阶层和教育水平较低的人，在生活在贫困指数较高的地区时，（p-相互作用分别=0.025和0.020），而非体力劳动者和受教育程度更高的参与者的风险在居住地区之间没有很大差异。结论居住区剥夺预测未来的住院率，住院时间和入院人数，与个人社会阶层、教育水平和其他行为因素无关。居住地剥夺对低文化程度或体力社会阶层的影响更大。相反，较高的教育水平和社会阶层减轻了面积剥夺与医院使用的关联。
Objectives To investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors.Design Prospective population-based study.Setting The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) study.Participants 11 214 men and 13 763 women in the general population, aged 40-79 years at recruitment (1993-1997), alive in 1999.Main outcome measure Total admissions to hospital and time spent in hospital during a 19-year time period (1999-2018).Results Compared to those with residential Townsend Area Deprivation Index lower than the average for England and Wales, those with a higher than average deprivation index had a higher likelihood of spending >20 days in hospital multivariable adjusted OR 1.18 (95% CI 1.07 to 1.29) and having 7 or more admissions OR 1.11 (95% CI 1.02 to 1.22) after adjustment for age, sex, smoking status, education, social class and body mass index. Occupational social class and educational attainment modified the association between area deprivation and hospitalisation; those with manual social class and lower education level were at greater risk of hospitalisation when living in an area with higher deprivation index (p-interaction=0.025 and 0.020, respectively), while the risk for non-manual and more highly educated participants did not vary greatly by area of residence.Conclusion Residential area deprivation predicts future hospitalisations, time spent in hospital and number of admissions, independently of individual social class and education level and other behavioural factors. There are significant interactions such that residential area deprivation has greater impact in those with low education level or manual social class. Conversely, higher education level and social class mitigated the association of area deprivation with hospital usage.