Sociodemographic Attributes and Spina Bifida Outcomes
Sociodemographic Attributes and Spina Bifida Outcomes
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DOI：
10.1542/peds.2014-2576
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发表时间：
2015-04-01
期刊：
影响因子：
8
通讯作者：
Thibadeau, Judy
中科院分区：
文献类型：
--
作者：
Schechter, Michael S.;Liu, Tiebin;Thibadeau, Judy
背景技术背景：国家脊柱裂患者登记处（NSBPR）于2009年开始，以帮助了解脊柱裂（SB）的自然史和SB诊所提供的治疗效果。我们使用NSBPR来探讨社会人口学特征与SB outcome.METHODS的关系：使用2009年至2012年收集的NSBPR数据，我们研究了人口学特征与4种SB结局之间的未校正关联：肠蠕动，膀胱蠕动，活动性和压疮的存在。然后，我们开发了多变量logistic模型，探讨这些关系，同时控制SB诊所，SB类型，和水平的lesions.RESULTS：数据可在2054例患者，22岁，从10 SB诊所。在多变量模型中，老年组更可能有褥疮和压疮，不太可能在社区走动。男性和没有私人保险的病人不太可能是大陆和社区门诊。非西班牙裔黑人不太可能是大陆人。病变程度与所有结果相关; SB类型与除压疮外的所有结果相关;除社区amnesty外，所有结果均显示出显著的临床sites. CONCLUSIONS：社会人口属性与SB结果相关。特别是，男性、非西班牙裔黑人和没有私人保险的患者的预后较差，年龄也有影响。这些特征需要由护理该患者人群的临床医生考虑，并在评估不同SB诊所之间临床和功能结局的差异时纳入病例组合调整。
BACKGROUND: A National Spina Bifida Patient Registry (NSBPR) was begun in 2009 to help understand the natural history of spina bifida (SB) and the effects of treatments provided by SB clinics. We used the NSBPR to explore the relationship of sociodemographic characteristics with SB outcomes.METHODS: Using NSBPR data collected in 2009 to 2012, we examined the unadjusted association between demographic characteristics and 4 SB outcomes: bowel continence, bladder continence, mobility, and presence of pressure sores. We then developed multivariable logistic models to explore these relationships while controlling for SB clinic, SB type, and level of lesion.RESULTS: Data were available on 2054 patients,22 years of age from 10 SB clinics. In the multivariable models, older age groups were more likely to have continence and pressure sores and less likely to be community ambulatory. Males and patients without private insurance were less likely to be continent and community ambulatory. Non-Hispanic blacks were less likely to be continent. Level of lesion was associated with all outcomes; SB type was associated with all but pressure sores; and all outcomes except community ambulation showed significant variation across clinic sites.CONCLUSIONS: Sociodemographic attributes are associated with SB outcomes. In particular, males, non-Hispanic blacks, and patients without private insurance have less favorable outcomes, and age has an impact as well. These characteristics need to be considered by clinicians who care for this patient population and factored into case-mix adjustment when evaluating variation in clinical and functional outcomes among different SB clinics.