Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State.
Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State.
复制标题
纽约州无家可归青年因自杀未遂而对医疗保健的利用情况。
DOI：
10.1093/aje/kwab037
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发表时间：
2021
影响因子：
5
通讯作者：
Kaplan,MarkS
中科院分区：
文献类型：
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作者：
Sakai-Bizmark,Rie;Kumamaru,Hiraku;Estevez,Dennys;Marr,EmilyH;Haghnazarian,Edith;Bedel,LaurenEM;Mena,LaurieA;Kaplan,MarkS
自杀仍然是无家可归青年的主要死亡原因。我们评估了无家可归和非无家可归的年轻人在自杀未遂后到急诊科或医院就诊的医疗保健利用的差异。纽约州住院和急诊部数据库(2009-2014)被用来识别10-17岁的无家可归和非无家可归的年轻人，他们在自杀未遂后使用了医疗保健服务。为了评估与无家可归的相关性，我们使用了暴力手段使用的Logistic回归模型、重症监护病房的利用率、住院费用的对数转换线性回归模型和住院时间的负二项回归模型。所有模型都根据个体特点进行了调整，具有医院随机效应和年份固定效应。我们确定了18,026次自杀企图，无家可归和非无家可归青年的卫生保健利用率分别为每100,000人年347.2次(95%可信区间：317.5,377.0)和67.3%(95%可信区间：66.3，68.3)。流浪青年住院时间明显长于非流浪青年(发病率比=1.53，95%CI：1.32，1.77)。所有在自杀未遂后去急诊科就诊的无家可归青年随后都被送往医院。这可能表明，与非无家可归的年轻人相比，无家可归的年轻人在陈述时具有更高的敏锐度。应制定针对无家可归青年的干预措施。
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and nonhomeless youth aged 10–17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.