Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy.
Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy.
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DOI：
10.1186/1471-2458-9-457
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发表时间：
2009-12-11
影响因子：
4.5
通讯作者：
Italian Study Group on Inequalities in Health Care
中科院分区：
文献类型：
--
作者：
Agabiti N;Pirani M;Schifano P;Cesaroni G;Davoli M;Bisanti L;Caranci N;Costa G;Forastiere F;Marinacci C;Russo A;Spadea T;Perucci CA;Italian Study Group on Inequalities in Health Care
在美国，特别是在老年人中，已经描述了初级卫生保健质量和可预防的住院治疗之间的关系。在欧洲，最近增加了对门诊护理敏感状况（ACSC）作为医疗保健质量指标的评价，但证据仍然有限。本研究的目的是确定在一个全民医疗保险覆盖的国家，收入水平是否与成人ACSC的较高住院率相关。从意大利四个城市（都灵、米兰、博洛尼亚、罗马）的医院登记中，我们确定了2000年因六种慢性疾病（糖尿病、高血压、充血性心力衰竭、心绞痛、慢性阻塞性肺病和哮喘）住院的9384例患者。病例定义基于卫生研究和质量-预防质量指标机构建议的ICD-9-CM编码算法。对每个人采用了基于地区的（人口普查区）收入指数。所有住院率均使用意大利人群按性别和年龄直接标准化。Poisson回归分析，以评估收入水平（五分位数）和住院率（RR，95%CI）之间的关系，分别为控制年龄，性别和居住城市的选定条件。总体而言，ACSC年龄标准化发病率为每10.000名居民26.1例。所有情况都显示出统计上显著的社会经济梯度，低收入者比富裕者更有可能住院。慢性阻塞性肺疾病（V级低收入对I级高收入RR = 4.23，95%CI 3.37-5.31）和充血性心力衰竭（RR = 3.78，95%CI = 3.09-4.62）的相关性尤其强。除哮喘外，男性比女性更容易患ACSC住院。45-64奥尔兹的风险高于年轻人。ACSC住院率的社会经济梯度证实了我国社会群体之间健康状况的差距。初级保健不足或无效被认为是加剧不平等的一个似乎合理的额外因素。这一发现突出表明，需要改善门诊护理方案，以减少穷人不必要的过度住院。
A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC) as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome), we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma) among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block) income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles) and hospitalization rates (RR, 95% CI) separately for the selected conditions controlling for age, gender and city of residence. Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31) and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62). With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year olds than in younger people. The socioeconomic gradient in ACSC hospitalization rates confirms the gap in health status between social groups in our country. Insufficient or ineffective primary care is suggested as a plausible additional factor aggravating inequality. This finding highlights the need for improving outpatient care programmes to reduce the excess of unnecessary hospitalizations among poor people.
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影响因子：
3
作者：
Culler, SD;Parchman, ML;Przybylski, M
通讯作者：
Przybylski, M
影响因子：
3
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3
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12.7
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通讯作者：
Brandt, S
影响因子：
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作者：
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通讯作者：
Coffey, RN