Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors.
Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors.
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DOI：
10.1111/j.1532-5415.2008.02002.x
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发表时间：
2008-12
影响因子：
6.3
通讯作者：
Sumner W
中科院分区：
文献类型：
--
作者：
Schootman M;Jeffe DB;Lian M;Deshpande AD;Gillanders WE;Aft R;Sumner W
评估生活在高度贫困地区(与低贫困地区相比)的乳腺癌幸存者对门诊护理敏感住院(ACSH)的频率，并检查ACSH的风险。前瞻性、多层次研究。我们分析了1991-1999年间以人口为基础的全国癌症研究所的监测、流行病学和最终结果计划数据，这些数据与全美的医疗保险索赔数据相关联。66岁或以上的乳腺癌幸存者。根据入院时的诊断对ACSH进行分类。生活在美国联邦贫困线以下的人口百分比是在人口普查区域一级计算的。潜在的混杂因素包括人口统计特征、合并症、肿瘤和治疗因素以及医疗服务的可获得性。在47643名女性中，13.3%的人至少有一次ACSH。居住在高贫困人口普查区(≥30%贫困率)的妇女在确诊后患至少一次急性胰腺炎的可能性是生活在低贫困人口普查区(10%贫困率)的妇女的1.52倍(95%可信区间：1.34-1.72)。在对大多数混杂因素进行调整后，结果保持不变。调整共病后，危险比(HR)降至1.34(95%CI：1.18-1.52)，但调整所有变量后，没有进一步降低与贫困率相关的ACSH风险(HR：1.37；95%CI：1.19-1.58)。生活在高贫困人口普查地区的老年乳腺癌幸存者可能会因为得不到ACSH建议的足够、及时和高质量的门诊初级护理而面临治疗后后续护理、预防性护理或症状管理减少的风险增加。
To estimate the frequency of ambulatory-care-sensitive hospitalizations (ACSH) and to examine risk of ACSH among breast cancer survivors living in high (compared with low) poverty areas. Prospective, multilevel study. We analyzed the national, population-based 1991-1999 National Cancer Institute’s Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States. Breast cancer survivors age 66 or older. ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the US federal poverty line was calculated at the census-tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care. 13.3% of 47,643 women had at least one ACSH. Women who lived in high-poverty census tracts (≥ 30% poverty rate) were 1.52 times (95% confidence interval [CI]: 1.34-1.72) more likely to have at least one ACSH after diagnosis than women who lived in low-poverty census tracts (< 10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI: 1.18-1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR: 1.37; 95% CI: 1.19-1.58). Elderly breast cancer survivors who lived in high-poverty census tracts may be at increased risk of reduced post-treatment follow-up care, preventive care, or symptom management as a result of not having adequate, timely, and high-quality ambulatory primary care as suggested by ACSH.
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DOI：
10.1093/gerona/57.6.m401
发表时间：
2002-06-01
影响因子：
5.1
作者：
Goodwin, JS;Freeman, JL;Nattinger, AB
通讯作者：
Nattinger, AB
影响因子：
2.5
作者：
Laditka, JN
通讯作者：
Laditka, JN
影响因子：
3
作者：
Culler, SD;Parchman, ML;Przybylski, M
通讯作者：
Przybylski, M
影响因子：
3.4
作者：
DeLia, D
通讯作者：
DeLia, D
影响因子：
3
作者：
Basu, J;Friedman, B;Burstin, H
通讯作者：
Burstin, H