Avoidable Acute Care Use for Vaccine-Preventable Illnesses Among Medicaid Beneficiaries With Lupus.
Avoidable Acute Care Use for Vaccine-Preventable Illnesses Among Medicaid Beneficiaries With Lupus.
复制标题
DOI：
10.1002/acr.24628
复制
发表时间：
2021-09
影响因子：
4.7
通讯作者：
Costenbader, Karen H.
中科院分区：
文献类型：
--
作者：
Feldman, Candace H.;Xu, Chang;Costenbader, Karen H.
近 25% 的 SLE 患者每年住院，通常是因为如果患者接受持续的门诊护理本可以避免的结果。我们检查了疫苗可预防疾病的急性护理使用情况，以确定社会人口因素和可修改的预测因素。利用美国 29 个州（2000-2010 年）的医疗补助索赔，我们确定了患有 SLE 患病率的成年人（18-65 岁），并且在第一个 SLE 代码（索引日期）之前入组 12 个月，以确定基线数据。我们将疫苗可预防疾病的急性护理用途定义为索引日期之后急诊科 (ED) 或出院诊断的流感、肺炎球菌疾病、脑膜炎球菌疾病、带状疱疹、高度宫颈不典型增生/宫颈癌和乙型肝炎。我们估计了疫苗可预防疾病的发病率 (IR)，并使用 Cox 回归根据社会人口因素和医疗保健利用率来评估风险（HR，95% CI），并根据疫苗接种、合并症和药物进行调整。在 45,654 名患有 SLE 的医疗补助受益人中，不到 10% 的人接种了疫苗。有 1,290 名患者因疫苗可预防的疾病就诊或住院次数≥1 次（每 1,000 人年中有 6.6 名患者）； 93% 的事件发生在未接种疫苗的患者中。与白人患者相比，黑人患者的风险高出 22%。门诊就诊次数越多，风险就越低。未接种疫苗的系统性红斑狼疮医疗补助受益人面临着因疫苗可预防疾病而接受本可避免的急性护理的风险。与白人患者相比，黑人患者的种族差异较高。更多的门诊使用与风险降低相关，这表明获得门诊护理可能会减少可避免的急性护理使用。
Nearly 25% of SLE patients are hospitalized yearly, often for outcomes that may have been avoided if patients had received sustained outpatient care. We examined acute care use for vaccine-preventable illnesses to determine sociodemographic contributors and modifiable predictors. Using U.S. Medicaid claims from 29 states (2000–2010), we identified adults (18–65 years) with prevalent SLE and 12 months of enrollment prior to the first SLE code (index date) to identify baseline data. We defined acute care use for vaccine-preventable illnesses as emergency department (ED) or hospital discharge diagnoses for influenza, pneumococcal disease, meningococcal disease, herpes zoster, high-grade cervical dysplasia/cervical cancer, and hepatitis B, after the index date. We estimated the incidence rate (IR) of vaccine-preventable illnesses and used Cox regression to assess risk (HR, 95% CI), by sociodemographic factors and healthcare utilization, adjusting for vaccinations, comorbidities and medications. Among 45,654 Medicaid beneficiaries with SLE, less than 10% received vaccinations. There were 1,290 patients with ≥1 ED visit or hospitalization for a vaccine-preventable illness (6.6 per 1,000 person-years); 93% of events occurred in unvaccinated patients. Patients who were Black compared to White had 22% higher risk. Greater outpatient visits were associated with lower risk. Medicaid beneficiaries with SLE who are not vaccinated are at risk for potentially avoidable acute care use for vaccine-preventable illnesses. Racial disparities were noted with a higher risk among Black compared to White patients. Greater outpatient use was associated with reduced risk, suggesting that access to ambulatory care may reduce avoidable acute care use.
登录
查看更多内容
影响因子：
3.7
作者：
Murray, Sara G.;Schmajuk, Gabriela;Yazdany, Jinoos
通讯作者：
Yazdany, Jinoos
影响因子：
4.8
作者：
Krishnarajah, Girishanthy;Carroll, Charlotte;Levin, Myron
通讯作者：
Levin, Myron
影响因子：
4.9
作者：
Yazdany, Jinoos;Tonner, Chris;Yelin, Edward H.
通讯作者：
Yelin, Edward H.
影响因子：
4.7
作者：
Feldman, Candace H.;Speyer, Cameron;Costenbader, Karen H.
通讯作者：
Costenbader, Karen H.
影响因子：
13.3
作者：
Feldman, Candace H.;Hiraki, Linda T.;Winkelmayer, Wolfgang C.;Marty, Francisco M.;Franklin, Jessica M.;Kim, Seoyoung C.;Costenbader, Karen H.
通讯作者：
Costenbader, Karen H.