Inequities in ambulance allocation associated with transfer delay and mortality in acute coronary syndrome patients: evidence from 89 emergency medical stations in China.
Inequities in ambulance allocation associated with transfer delay and mortality in acute coronary syndrome patients: evidence from 89 emergency medical stations in China.
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救护车分配不公平与急性冠脉综合征患者转运延误和死亡率相关：来自中国89个急救医疗站的证据
DOI：
10.1186/s12939-022-01777-3
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发表时间：
2022-12-16
影响因子：
4.8
通讯作者：
Zheng, Zhi-Jie
中科院分区：
文献类型：
--
作者：
Li, Siwen;Dong, Xuejie;Li, Dongmei;Zhang, Hongjuan;Zhou, Shuduo;Maimaitiming, Mailikezhati;Ma, Junxiong;Li, Na;Zhou, Qiang;Jin, Yinzi;Zheng, Zhi-Jie
关键词：
研究背景医疗资源的配置对患者的治疗和预后有很大的影响。本研究的目的是评估不同地区救护车配置的不平等性，并估计救护车密度与急性冠脉综合征（ACS）患者院前转运时间和死亡率之间的关系。方法本横断面研究基于31家医院3588例ACS患者的电子医疗系统集成数据库，89个急救医疗站的救护车信息，和中国深圳市8个区的公共地理信息。主要结果是救护车分配和转移延迟与ACS患者住院死亡率之间的关系。采用泰尔指数和基尼系数评价救护车配置的公平性和不公平性。结果深圳市救护车配置存在显著的不均衡性（Theil指数：0. 59），各区之间的不均衡性（Theil指数：0. 38）大于区内的不均衡性（Theil指数：0. 21）。各地区之间的转移延误、救护车配置和死亡率的差距程度导致基尼系数分别为0.35、0.53和0.65。救护车密度与院前转运时间呈负相关（OR = 0.79，95%CI：0.64，0.97，P = 0.026），与院内死亡率呈负相关（OR = 0.31，95%CI：0.14，0.70，P = 0.005）。Theil指数对转运时间和院内死亡率的OR值分别为1.09（95%CI：1.01，1.10，P < 0.001）和1.80（95%CI：1.15，3.15，P = 0.009）。建议增加救护车的可及性，开展公众健康教育。
BackgroundAllocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients.MethodsThis cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations.ResultsThere was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97,P= 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70,P= 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10,P< 0.001) and 1.80 (95%CI:1.15,3.15,P= 0.009), respectively.ConclusionsRegional inequities existed in ambulance allocation and has a significant impact on pre-hospital transfer delay and in-hospital mortality of ACS patients. It was suggested to increase the ambulance accessibility and conduct health education for public.
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影响因子：
3.7
作者：
Dharma S
通讯作者：
Dharma S
影响因子：
6.5
作者：
Kurz, Michael Christopher;Schmicker, Robert H.;Wang, Henry E.
通讯作者：
Wang, Henry E.
影响因子：
3.7
作者：
Hagihara A;Hasegawa M;Abe T;Nagata T;Nabeshima Y
通讯作者：
Nabeshima Y
DOI：
10.1111/1742-6723.12399
发表时间：
2015-06
期刊：
Emergency medicine Australasia : EMA
影响因子：
--
作者：
Crilly J;Keijzers G;Tippett V;O'Dwyer J;Lind J;Bost N;O'Dwyer M;Shiels S;Wallis M
通讯作者：
Wallis M
影响因子：
5.7
作者：
Galappatthy, Priyadarshani;Bataduwaarachchi, Vipula R.;Ekanayaka, Ruvan
通讯作者：
Ekanayaka, Ruvan