The incidence and mortality for meningococcal disease associated with area deprivation: an ecological study of hospital episode statistics
The incidence and mortality for meningococcal disease associated with area deprivation: an ecological study of hospital episode statistics
复制标题
DOI：
10.1136/adc.2003.036004
复制
发表时间：
2004-11-01
影响因子：
5.2
通讯作者：
Somerset, M
中科院分区：
文献类型：
--
作者：
Heyderman, RS;Ben-Shlomo, Y;Somerset, M
目的：确定脑膜炎双球菌病(MD)的发病率、死亡率和病死率是否因区域剥夺而不同，以及这种差异是否随时间的变化而变化。方法：分析1995-99和1991-94两个时间段内5岁以下MD儿童的面积剥夺分数的五分之一。计算每年的年龄标化率，用泊松回归分析发病率、死亡率和区域剥夺五分位数之间的关系，并确定危险比。结果：共发生MD 10524例，死亡441例(4.2%)。1995年至1999年的发病率(45.4/100000)高于1991年至1994年的发病率(27.4/100000)。随着时间的推移，死亡率保持稳定，表明死亡风险下降了约40%。最贫穷的五分之一人口的发病率大约是最富裕的五分之一人口的两倍，但随着时间的推移，这种梯度会下降。最高和最低五分位数的死亡率存在三重梯度，随着时间的推移是恒定的。死亡的几率不是线性的，死亡率最低的是第一个地区，最高的是第二个和第五个地区。结论：这些数据表明MD的发病率和死亡率是社会模式的。病死率的决定因素更为复杂，需要进一步调查。
Aims: To determine whether incidence, mortality, and case fatality for meningococcal disease ( MD) differs by area deprivation, and if this has changed over time.Methods: The population of children aged less than 5 years with MD was analysed as quintiles of area deprivation scores over two time periods, 1995-99 and 1991-94. Annual age standardised rates were calculated and the association between incidence, mortality, and area deprivation quintiles assessed using Poisson regression and the risk ratios determined. Case fatality was calculated from the odds ratio of mortality by area deprivation score for the two time periods.Results: There were 10 524 cases of MD and 441 deaths (4.2%). Incidence rates were higher for 1995-99 (45.4 per 100000) compared to 1991-94 (27.4 per 100000). Mortality rates remained stable over time, indicating a decline in risk of death of around 40%. The incidence rates for the most deprived quintile were around twice those for the most affluent quintile, but this gradient declined over time. A threefold gradient was seen for mortality rates across the top and bottom quintiles, which was constant over time. The odds of mortality did not show a linear pattern, with mortality being lowest in the first and highest in the second and fifth area deprivation quintiles.Conclusions: These data show that MD incidence and mortality are socially patterned. The determinants of case fatality are more complex and require further investigation.