Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department: a retrospective cohort study
Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department: a retrospective cohort study
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DOI：
10.1136/bmjopen-2017-019318
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发表时间：
2017-12-01
期刊：
影响因子：
2.9
通讯作者：
Haak, Harm R.
中科院分区：
文献类型：
--
作者：
Wachelder, Joyce J. H.;van Drunen, Isabelle;Haak, Harm R.
目的老年人急诊科（ED）就诊频繁。社会经济地位（SES）对健康和ED利用有重要影响；然而，老年人SES和ED使用之间的关系尚不清楚。本研究的目的是调查老年急诊科患者SES与预后之间的关系。设计回顾性研究。参与者：荷兰急诊科的老年人（bb0 = 65岁）。SES根据邮政编码水平的平均家庭收入分层：低（(sic)2300/月）。主要结局住院、院内死亡率和30天急诊科复诊。通过逻辑回归评估SES对所有组结果的影响，并对混杂因素进行校正。结果在研究期间，共有4828名老年人访问了急诊科。与社会经济地位高的患者相比，社会经济地位低的社区居住患者的住院风险更高（调整OR为1.3,95% CI为1.1至1.7）。这种关联不存在于中等社会地位（校正OR 1.1, 95% CI 0.95 ~ 1.4）。即使在调整了年龄、合并症和分诊水平后，低SES组和高SES组的住院死亡率也具有可比性（低OR 1.4, 95% CI 0.8至2.6，中等OR 1.3, 95% CI 0.8至2.2）。社区居住患者30天ED回访在SES组之间也相同（低：调整OR 1.0, 95% CI 0.7至1.4，中等：调整OR 0.8, 95% CI 0.6至1.1）。结论在老年ED患者中，低SES比高SES有更高的住院风险。然而，在调整混杂因素后，SES对住院死亡率和30天ED复诊没有影响。
Objectives Older adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.Design A retrospective study.Participants Older adults (>= 65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low ((sic)2300/month).Primary outcomes Hospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.Results In total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).Conclusion In older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.