How can socioeconomic inequalities in hospital admissions be explained? A cohort study
How can socioeconomic inequalities in hospital admissions be explained? A cohort study
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DOI：
10.1136/bmjopen-2012-002433
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Watt, Graham
中科院分区：
文献类型：
--
作者：
McCartney, Gerry;Hart, Carole;Watt, Graham
目的：探讨哪些前因危险因素可以解释医院使用中的社会模式。设计：前瞻性队列研究，随访长达37年。背景：苏格兰西部具有代表性的社区样本。参与者：从1972年至1976年的普通人群中招募了7049名男性和8353名女性，年龄在45-64岁之间（占合格人群的78%）。主要和次要结局指标：按病因和按急诊或非急诊分类的住院人数和住院天数。结果：与社会阶层I和II相比，社会阶层IV和V的女性（RR 1.04, 95% CI 0.98至1.10）或男性（RR 1.0, 95% CI 0.94至1.06）的全因住院率比（RRs）没有明显的社会模式。然而，女性的心血管疾病、冠心病和中风，以及男性和女性的呼吸系统疾病都具有社会模式，尽管随着基线风险因素的增加，这种模式显著减弱。住院天数通常是社会模式，差异主要是由基线风险因素解释的。相比之下，社会IV和V阶层的女性（RR 1.77, 95% CI 1.38 - 2.27）和男性（RR 1.51, 95% CI 1.11 - 2.06）与社会I和II阶层相比，心理健康入院的总体RRs呈社会模式，但这种模式并没有随着基线危险因素的增加而减弱。急诊住院与低社会阶层相关，而非急诊住院与低社会阶层相关。结论：总体住院率仅与边际社会模式有关，低于基线风险梯度的预期。然而，心理健康问题的入院有明显的社会模式。非紧急住院率与风险成反比。需要进一步的工作来解释和解决这种不公平的医疗保健使用梯度。
Objectives: To investigate which antecedent risk factors can explain the social patterning in hospital use.Design: Prospective cohort study with up to 37 years of follow-up.Setting: Representative community sample in the West of Scotland.Participants: 7049 men and 8353 women aged 45-64 years were recruited into the study from the general population between 1972 and 1976 (78% of the eligible population).Primary and secondary outcome measures: Hospital admissions and bed days by cause and by classification into emergency or non-emergency.Results: All-cause hospital admission rate ratios (RRs) were not obviously socially patterned for women (RR 1.04, 95% CI 0.98 to 1.10) or men (RR 1.0, 95% CI 0.94 to 1.06) in social classes IV and V compared with social classes I and II. However, cardiovascular disease, coronary heart disease and stroke in women, and respiratory disease for men and women were socially patterned, although this attenuated markedly with the addition of baseline risk factors. Hospital bed days were generally socially patterned and the differences were largely explained by baseline risk factors. The overall RRs of mental health admissions in contrast were socially patterned for women (RR 1.77, 95% CI 1.38 to 2.27) and men (RR 1.51, 95% CI 1.11 to 2.06) in social classes IV and V compared with social classes I and II, but the pattern did not attenuate with the addition of baseline risk factors. Emergency hospital admissions were associated with lower social class, but there was an inverse relationship for non-emergency hospital admissions.Conclusions: Overall admissions to hospital were only marginally socially patterned, and less than would be expected on the basis of the gradient in baseline risk. However, there was marked social patterning in admissions for mental health problems. Non-emergency hospital admissions were patterned inversely according to risk. Further work is required to explain and address this inequitable gradient in healthcare use.