Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery.
Neighborhood-Level Social Disadvantage and Risk of Delirium Following Major Surgery.
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大手术后，社区级别的社会劣势和ir妄的风险。
DOI：
10.1111/jgs.16782
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发表时间：
2020-12
影响因子：
6.3
通讯作者：
Inouye SK
中科院分区：
文献类型：
--
作者：
Arias F;Chen F;Fong TG;Shiff H;Alegria M;Marcantonio ER;Gou Y;Jones RN;Travison TG;Schmitt EM;Kind AJH;Inouye SK
谵妄是一种常见的术后并发症，与住院时间延长、再次住院和过早死亡有关。我们探讨了社区水平的特征与谵妄发病率和严重程度之间的关系，并比较了社区水平与个人水平的社会经济状况指标在预测谵妄发病率方面的差异。在2010年6月18日至2013年8月8日期间入组的前瞻性观察性患者队列。术前进行基线访谈，住院期间每天评价谵妄/谵妄严重程度。评估谵妄的研究人员对基线认知状态不知情。位于马萨诸塞州波士顿的两个学术医疗中心。560名70岁以上的老年人接受重大非心脏手术。区域发展指数（ADI）被用来描述每个社区的社会经济劣势。谵妄使用混乱评估方法（CAM）长形式进行评估。使用每日医院评估期间发生的CAM-S最高值（CAM-S峰值）计算谵妄严重程度。居住在最不利的社区（ADI>44）与更高的事件性谵妄风险（12/26，46%）相关，与最不不利的社区（122/534，23%）相比，风险比，RR，[95%置信区间，CI] = 2.0 [1.3，3.1]。CAM-S峰值评分与ADI显著相关（斯皮尔曼等级相关，rho = 0.11，p= 0.009）。平均CAM-S峰值得分一般从3.7上升到5.3，在不断增加的邻里劣势水平。与社会经济地位和文化背景的个体水平标记相关的RR [95%CI]为：教育≤ 12年为1.2 [0.9-1.7];非白人为1.3 [0.8-2.1];家庭年收入<20，000美元为1.7 [1.1-2.6]。在预测谵妄风险的效应量或显著性方面，这些个体水平标志物均未超过ADI。社区水平的社会不利因素与谵妄的发病率和严重程度有关，并表现出一种确定-反应关系。未来的研究应该考虑背景水平的指标，如ADI，作为社会劣势的风险标志，可以帮助指导谵妄的治疗和预防。
Delirium is a common postoperative complication associated with prolonged length of stay, hospital readmission, and premature mortality. We explored the association between neighborhood-level characteristics and delirium incidence and severity, and compare neighborhood- with individual-level indicators of socioeconomic status in predicting delirium incidence. A prospective observational cohort of patients enrolled between June 18, 2010 and August 8, 2013. Baseline interviews were conducted prior to surgery and delirium/delirium severity were evaluated daily during hospitalization. Research staff evaluating delirium were blinded to baseline cognitive status. Two academic medical centers in Boston, Massachusetts. 560 older adults aged 70+ undergoing major non-cardiac surgery. The Area Deprivation Index (ADI) was used to characterize each neighborhood’s socioeconomic disadvantage. Delirium was assessed using the Confusion Assessment Method (CAM) long-form. Delirium severity was calculated using the highest value of CAM-S occurring during daily hospital assessments (CAM-S Peak). Residing in the most disadvantaged neighborhoods (ADI>44) was associated with a higher risk of incident delirium (12/26, 46%), compared with the least disadvantaged neighborhoods (122/534, 23%), risk ratio, RR, [95% confidence interval, CI] = 2.0 [1.3, 3.1]. The CAM-S Peak score was significantly associated with ADI (Spearman rank correlation, rho =.11, p=.009). Mean CAM-S Peak scores generally rose from 3.7 to 5.3 across levels of increasing neighborhood disadvantage. The RR [95% CI] associated with individual-level markers of socioeconomic status and cultural background were: 1.2 [0.9–1.7] for education ≤ 12 years; 1.3 [0.8–2.1] for non-white race; and 1.7 [1.1–2.6] for annual household income <$20,000. None of these individual-level markers exceeded the ADI in terms of effect size or significance for prediction of delirium risk. Neighborhood-level makers of social disadvantage are associated with delirium incidence and severity, and demonstrated an exposure-response relationship. Future studies should consider contextual-level metrics, such as the ADI, as risk markers of social disadvantage that can help to guide delirium treatment and prevention.
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影响因子：
39.2
作者：
Kind AJ;Jencks S;Brock J;Yu M;Bartels C;Ehlenbach W;Greenberg C;Smith M
通讯作者：
Smith M
CAM-S：在2个队列中del妄严重性的新评分系统的开发和验证。
影响因子：
39.2
作者：
Inouye SK;Kosar CM;Tommet D;Schmitt EM;Puelle MR;Saczynski JS;Marcantonio ER;Jones RN
通讯作者：
Jones RN
影响因子：
39
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
3.4
作者：
Durfey, Shayla N. M.;Kind, Amy J. H.;Trivedi, Amal N.
通讯作者：
Trivedi, Amal N.