Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery
Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery
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DOI：
10.1111/j.1475-6773.2012.01449.x
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发表时间：
2013-04-01
影响因子：
3.4
通讯作者：
Bazemore, Andrew W.
中科院分区：
文献类型：
--
作者：
Butler, Danielle C.;Petterson, Stephen;Bazemore, Andrew W.
目的建立一个新的地理水平，初级保健服务区的社会剥夺与卫生保健获得和健康结果的措施。数据来源/研究设置对来自达特茅斯地图集、AMA主文件、国家提供者标识符数据、小区域健康保险估计、美国社区调查、区域资源文件和行为风险因素监测系统的数据进行二次分析。数据汇总到初级保健服务区（PCSA）。研究设计社会剥夺变量选自文献综述和国际例子。采用因子分析法。相关性和多变量分析之间的指数，健康结果，和措施的卫生保健获得。将所得出的指数与作为健康结果预测指标的贫穷进行比较。数据收集/提取方法在区组水平估计在PCSA水平不可用的变量，然后汇总到PCSA水平。主要结果我们的社会剥夺指数是正相关的访问和不良的健康结果。这种模式适用于控制其他访问措施的多变量分析。一个多层面的贫困衡量标准与健康结果的联系比单独的贫困衡量标准更紧密。结论：该地理指数具有实用性，以确定需要援助的领域，是及时的35岁的供应商短缺和地理服务不足的指定标准，用于分配联邦资源的修订。
Objective To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area. Data Sources/Study Setting Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs). Study Design Social deprivation variables were selected from literature review and international examples. Factor analysis was used. Correlation and multivariate analyses were conducted between index, health outcomes, and measures of health care access. The derived index was compared with poverty as a predictor of health outcomes. Data Collection/Extraction Methods Variables not available at the PCSA level were estimated at block level, then aggregated to PCSA level. Principal Findings Our social deprivation index is positively associated with poor access and poor health outcomes. This pattern holds in multivariate analyses controlling for other measures of access. A multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone. Conclusions This geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources.