Inequities in Ambulatory Care and the Relationship Between Socioeconomic Status and Respiratory Hospitalizations: A Population-Based Study of a Canadian City
Inequities in Ambulatory Care and the Relationship Between Socioeconomic Status and Respiratory Hospitalizations: A Population-Based Study of a Canadian City
复制标题
DOI：
10.1370/afm.1683
复制
发表时间：
2014-09-01
影响因子：
4.4
通讯作者：
Katz, Alan
中科院分区：
文献类型：
--
作者：
Trachtenberg, Aaron J.;Dik, Natalia;Katz, Alan
社会经济地位较低的个体因对门诊护理敏感的疾病，特别是慢性阻塞性肺病和哮喘，住院率较高。我们研究了患者人口统计学、门诊护理使用或医生特征的差异是否可以解释可避免的住院率的差异。方法使用加拿大马尼托巴省温尼伯市的行政数据，我们确定了所有18至70岁的慢性阻塞性肺疾病或哮喘的成年人，将其分组为阻塞性气道疾病。我们使用平均家庭收入将患者划分为人口普查所得收入的五分之一。我们进行了一系列多变量逻辑回归分析，以确定在控制了与患者人口统计学相关的协变量后，社会经济地位与阻塞性气道疾病相关住院风险的关系如何变化（社会经济地位、年龄、性别和合并症），门诊护理使用（流感疫苗接种和专科转诊的连续性），以及患者的主治医生的特征结果我们纳入了34，741例阻塞性气道疾病患者，其中729例（2.1%）在2年期间因相关诊断住院。收入较低的患者比收入最高的患者更有可能住院，在控制了所有其他变量后，社会经济地位的这种影响几乎没有变化。在一个完全调整的模型中，收入最低的五分之一人群的住院几率大约是收入最高的五分之一人群的3倍（比值比= 2.93; 95%置信限：结论在全民保健的背景下，基于收入的呼吸道门诊治疗住院差异-敏感情况不能用与使用流动服务直接有关的因素来解释，而这些因素可以用行政数据来衡量。我们的研究结果表明，我们应该超越医疗保健系统，着眼于更广泛的健康社会决定因素，以减少穷人中可避免的住院人数。
PURPOSE Individuals of lower socioeconomic status have higher rates of hospitalization due to ambulatory care-sensitive conditions, particularly chronic obstructive pulmonary disease and asthma. We examined whether differences in patient demographics, ambulatory care use, or physician characteristics could explain this disparity in avoidable hospitalizations.METHODS Using administrative data from the city of Winnipeg, Manitoba, Canada, we identified all adults aged 18 to 70 years with chronic obstructive pulmonary disease or asthma, grouped together as obstructive airway disease. We divided patients into census-derived income quintiles using average household income. We performed a series of multivariate logistic regression analyses to determine how the association of socioeconomic status with the risk of obstructive airway disease-related hospitalizations changed after controlling for blocks of covariates related to patient demographics (socioeconomic status, age, sex, and comorbidity), ambulatory care use (continuity influenza vaccination and specialist referral), and characteristics of the patient's usual physician (eg, payment mechanism, sex, years in practice).RESULTS We included 34,741 patients with obstructive airway disease, 729 (2.1%) of whom were hospitalized with a related diagnosis during a 2-year period. Patients having a lower income were more likely to be hospitalized than peers having the highest income, and this effect of socioeconomic status remained virtually unchanged after controlling for every other variable studied. In a fully adjusted model, patients in the lowest income quintile had approximately 3 times the odds of hospitalization relative to counterparts in the highest income quintile (odds ratio = 2.93; 95% confidence limits: 2.19, 3.93).CONCLUSIONS In the setting of universal health care, the income-based disparity in hospitalizations for respiratory ambulatory care-sensitive conditions cannot be explained by factors directly related to the use of ambulatory services that can be measured using administrative data. Our findings suggest that we look beyond the health care system at the broader social determinants of health to reduce the number of avoidable hospitalizations among the poor.