Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study
Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study
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DOI：
10.1111/j.1528-1167.2008.01898.x
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发表时间：
2009-05-01
期刊：
影响因子：
5.6
通讯作者：
Shih, Tina
中科院分区：
文献类型：
--
作者：
Begley, Charles E.;Basu, Rituparna;Shih, Tina
本研究的目的是确定社会人口统计学差异的医疗保健使用癫痫患者接受护理在不同的网站和程度的差异持续调整后，患者的特点和网站的care.Three个月的医疗保健使用数据的基线访谈约560例患者在四个网站。一半的患者来自休斯顿的一个站点和纽约市的两个站点，这些站点主要为低收入，少数民族，公共保险或无保险的患者提供服务。另一半是在休斯顿的剩余站点，为更平衡的种族/民族和更高的社会人口提供服务。普通和专科就诊、医院急诊室（ER）护理和住院治疗的差异与种族/民族、收入和覆盖范围相关。Logistic回归分析用于评估在调整个体患者特征和护理地点后，差异持续的程度。与白人相比，黑人和西班牙裔有更高的全科医生就诊率[比值比（OR）= 5.3和4.9，p <0.05），ER护理（OR = 3.1和2.9，p <0.05）和住院（OR = 5.4和6.2，p <0.05），以及更低的专家就诊率（OR = 0.3和0.4，p <0.05）。类似的模式被发现与病人的收入和覆盖范围有关。的幅度和意义的差异持续调整时，个人特征，但大幅下降或被消除时，网站的护理被添加到model.There的社会人口学差异，在很大程度上解释了在哪里接受治疗的癫痫患者的医疗保健。
The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care.Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage. Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care.Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model.There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care.