Disparities in Spatial Access to Emergency Surgical Services in the US.
Disparities in Spatial Access to Emergency Surgical Services in the US.
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DOI：
10.1001/jamahealthforum.2022.3633
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发表时间：
2022-10-07
期刊：
影响因子：
--
通讯作者：
Horns, Joshua J.
中科院分区：
文献类型：
--
作者：
McCrum, Marta L.;Wan, Neng;Han, Jiuying;Lizotte, Steven L.;Horns, Joshua J.
急诊外科服务的空间可及性在美国各地有何不同？与低可及性相关的社区特征是什么？在这项采用先进地理空间指标的横断面研究中，2015年美国3.2亿居民的距离、医院容量和人口需求被纳入研究范围，估计每10名居民中就有1人无法进入任何具有紧急手术能力的医院，每4名居民中就有1人无法进入拥有先进临床资源的医院。在小城市和农村地区，没有保险、公共保险以及种族和少数民族群体比例高的社区处于低通道地区的风险最大。美国各地急诊外科护理的空间可及性存在巨大差异；应采用空间可及性的综合指标，如增强的两步浮动集水区模型，以确定外科卫生系统发展的目标。提供紧急外科服务的医院为各种时间敏感型疾病提供基本护理。与更全面的度量方法相比，常用的空间进入度量方法，如距离或旅行时间，被证明低估了差异。使用增强的两步浮动集水法（E2SFCA）研究美国具有急诊外科能力的医院的空间可达性在人口水平上的差异。使用2015年美国社区调查数据的横断面研究。将全国人口普查街区组（CBG）的社区特征数据与设有急诊科和住院外科服务的医院的地理坐标配对，确定具有先进临床资源的医院。使用空间访问比（SPAR）测量空间访问，SPAR是一种E2SFCA方法，可捕获到医院的距离、人口需求和医院容量。进行了小区域分析，以评估低可及性的人群和与低空间可及性相关的社区特征。数据分析时间为2021年2月至2022年7月。低空间可达性定义为SPAR比全国平均水平低1.0 SD （SPAR <0.3）。在217 663例cbg （cbg年龄中位数为39.7[33.7-46.3]岁）中，有急诊手术能力的医院有3853家，有先进临床资源的医院有1066家（27.7%）。在3.2亿居民中，有3080万人（9.6%）无法进入任何提供紧急手术服务的医院，8260万人（25.8%）无法进入高级资源中心。在所有情况下，保险状况与低护理可及性相关（公共保险：调整费率比[aRR]， 1.21; 95% CI, 1.12-1.25；未保险的aRR， 1.58; 95% CI, 1.52-1.64）。在小城市和农村地区，高比例的西班牙裔和其他（亚洲人、美洲印第安人、阿拉斯加原住民或太平洋岛民；以及2个或更多的种族和少数民族群体）社区也与低入学率有关。在获得先进资源医院方面也出现了类似的模式，但存在更明显的种族和族裔差异。在这项关于外科护理可及性的横断面研究中，近十分之一的美国居民到任何一家提供紧急外科服务的医院就诊的空间可及性较低，四分之一的居民到拥有先进临床资源的医院就诊的空间可及性较低。没有保险或公共保险的居民比例较高的社区以及小城市和农村地区的种族和少数民族社区获得紧急外科护理的机会有限的风险最大。这些发现支持了E2SFCA模型在识别外科护理空间可及性低的地区和指导卫生系统发展方面的应用。这项横断面研究使用先进的地理空间指标，包括距离、医院容量和人口需求，估计了美国各地急诊外科医院的可及性差异。
How does spatial access to emergency surgical services vary across the US, and what community characteristics are associated with low access to care? In this cross-sectional study using advanced geospatial metrics that capture distance, hospital capacity, and population demand for all 320 million US residents in 2015, an estimated 1 in 10 residents experienced low access to any hospital with emergency surgical capabilities, and 1 in 4 experienced low access to hospitals with advanced clinical resources. Communities with high proportions of uninsured, publicly insured, and racial and ethnic minority groups in micropolitan and rural regions were at the greatest risk of being in low-access areas. Substantial disparities exist in spatial access to emergency surgical care across the US; comprehensive metrics of spatial access, such as enhanced 2-step floating catchment models, should be adopted to identify targets for surgical health system development. Hospitals with emergency surgical services provide essential care for a wide range of time-sensitive diseases. Commonly used measures of spatial access, such as distance or travel time, have been shown to underestimate disparities compared with more comprehensive metrics. To examine population-level differences in spatial access to hospitals with emergency surgical capability across the US using enhanced 2-step floating catchment (E2SFCA) methods. A cross-sectional study using the 2015 American Community Survey data. National census block group (CBG) data on community characteristics were paired with geographic coordinates of hospitals with emergency departments and inpatient surgical services, and hospitals with advanced clinical resources were identified. Spatial access was measured using the spatial access ratio (SPAR), an E2SFCA method that captures distance to hospital, population demand, and hospital capacity. Small area analyses were conducted to assess both the population with low access to care and community characteristics associated with low spatial access. Data analysis occurred from February 2021 to July 2022. Low spatial access was defined by SPAR greater than 1.0 SD below the national mean (SPAR <0.3). In the 217 663 CBGs (median [IQR] age for CBGs, 39.7 [33.7-46.3] years), there were 3853 hospitals with emergency surgical capabilities and 1066 (27.7%) with advanced clinical resources. Of 320 million residents, 30.8 million (9.6%) experienced low access to any hospital with emergency surgical services, and 82.6 million (25.8%) to advanced-resource centers. Insurance status was associated with low access to care across all settings (public insurance: adjusted rate ratio [aRR], 1.21; 95% CI, 1.12-1.25; uninsured aRR, 1.58; 95% CI, 1.52-1.64). In micropolitan and rural areas, high-share (>75th percentile) Hispanic and other (Asian; American Indian, Alaska Native, or Pacific Islander; and 2 or more racial and ethnic minority groups) communities were also associated with low access. Similar patterns were seen in access to advanced-resource hospitals, but with more pronounced racial and ethnic disparities. In this cross-sectional study of access to surgical care, nearly 1 in 10 US residents experienced low spatial access to any hospital with emergency surgical services, and 1 in 4 had low access to hospitals with advanced clinical resources. Communities with high rates of uninsured or publicly insured residents and racial and ethnic minority communities in micropolitan and rural areas experienced the greatest risk of limited access to emergency surgical care. These findings support the use of E2SFCA models in identifying areas with low spatial access to surgical care and in guiding health system development. This cross-sectional study estimates differences in access to hospitals with emergency surgical capability across the US using advanced geospatial metrics that capture distance, hospital capacity, and population demand.
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影响因子：
9
作者：
Gomez, David;Haas, Barbara;Nathens, Avery B.
通讯作者：
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影响因子：
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作者：
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影响因子：
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作者：
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DOI：
10.1016/j.jamcollsurg.2007.12.017
发表时间：
2008-05-01
影响因子：
5.2
作者：
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通讯作者：
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影响因子：
9
作者：
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通讯作者：
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