Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture
Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture
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DOI：
10.1093/intqhc/mzp046
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发表时间：
2009-12-01
影响因子：
2.6
通讯作者：
Perucci, Carlo Alberto
中科院分区：
文献类型：
--
作者：
Barone, Anna Patrizia;Fusco, Danilo;Perucci, Carlo Alberto
在国家卫生服务体系提供全民健康覆盖的国家，社会经济地位不应影响卫生保健的质量。我们研究了社会经济地位是否在髋部骨折后的短期死亡率和等待手术时间中起作用。回顾性队列研究。从医院信息系统数据库中，我们选择了2006年1月1日至2007年11月30日期间在罗马急性护理医院因髋部骨折入院的所有年龄在65岁以上的患者。每个人的社会经济地位是根据个人居住的人口普查区使用特定城市的社会经济变量指数获得的。定义了三种不同的结果：手术等待时间、30天内死亡率和髋部骨折入院后48小时内的干预。我们使用逻辑回归估计30天死亡率，并使用Cox比例风险模型计算48小时内干预的风险比。中位等待时间通过调整Kaplan-Meyer曲线估计。根据年龄、性别和共存的医疗条件对分析进行了调整。低社会经济水平与较高的死亡风险显著相关[校正相对风险(RR) = 1.51；P < 0.05]且早期干预风险较低（校正RR = 0.32; P < 0.001）。社会经济水平对30天内的等待时间也有影响。生活在弱势人口普查区的个人预后较差，尽管全民医疗保健覆盖，但他们比更富裕的人更不可能根据临床指南接受治疗。
In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic position plays a role in short-term mortality and waiting time for surgery after hip fracture.Retrospective cohort study.From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence.Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan-Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions.Low socioeconomic level was significantly associated with higher risk of mortality [adjusted relative risk (RR) = 1.51; P < 0.05] and lower risk of early intervention (adjusted RR = 0.32; P < 0.001). Socioeconomic level had also an effect on waiting times within 30 days.Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage.