Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed?
Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed?
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DOI：
10.2147/clep.s218322
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Sogaard, Rikke
中科院分区：
文献类型：
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作者：
Hyldgard, Vibe Bolvig;Johnsen, Soren Paaske;Sogaard, Rikke
目的：中风护理的社会经济不平等甚至发生在免费获得医疗保健的国家。我们的目的是调查社会经济地位和指南推荐的急性护理在丹麦在过去decent.Design之间的关联：我们进行了一项全国性的，以人群为基础的研究。我们使用家庭收入，就业状况和教育作为社会经济地位的标志，并调整了相关临床协变量的结果。我们使用加权线性回归模型分析患者水平绩效指标实现的经验对数几率。设置：丹麦的公立医院。参与者：2004年至2014年期间共有110，848名连续卒中患者出院。干预措施：根据临床指南进行急性卒中护理。主要结局指标：基于临床性能指标，以两种方式定义指南推荐的护理：整个研究期间使用的已完成测量的百分比（m=8）（模型1）和出院时使用的已完成测量的百分比结果：与高家庭收入相比，低家庭收入与指南推荐的治疗呈负相关;模型1和模型2的优势比（95%CI）分别为0.89（0.85-0.93）和0.81（0.77-0.85）。低家庭收入与16项绩效指标中的14项呈负相关。在一般情况下，随着时间的推移，完成的绩效指标的百分比增加从70%（95%CI 63-76）到85%（95%CI 83-87）。结论：社会经济不平等的指南推荐的中风护理仍然存在，尽管在一个环境的整体改善，免费获得护理和系统监测的医疗保健质量。
Purpose: Socioeconomic inequality in stroke care occurs even in countries with free access to health care. We aimed to investigate the association between socioeconomic status and guideline-recommended acute care in Denmark during the last decade.Design: We conducted a nationwide, population-based study. We used household income, employment status, and education as markers of socioeconomic status and adjusted the results for relevant clinical covariates. We used weighted linear regression models to analyse empirical log odds of performance measure fulfillment at patient level.Setting: Public hospitals in Denmark.Participants: A total of 110,848 consecutive stroke patients discharged between 2004 and 2014.Intervention(s): Acute stroke care according to clinical guidelines.Main outcome measure(s): Guideline-recommended care was defined in two ways based on clinical performance measures: the percentage of fulfilled measures used throughout the study period (m=8) (model 1) and the percentage of fulfilled measures used at the time of discharge (m=8 to 16) (model 2).Results: Compared with high family income, low income was negatively associated with the guideline-recommended care; odds ratios (95% CI) were 0.89 (0.85-0.93) in model 1 and 0.81 (0.77-0.85) in model 2. Low family income was negatively associated with fulfillment of 14 of the 16 performance measures. In general, the percentage of performance measures fulfilled increased over time from 70% (95% CI 63-76) to 85% (95% CI 83-87).Conclusion: Socioeconomic inequality in guideline-recommended stroke care remains despite overall improvements in a setting with free access to care and systematic monitoring of health care quality.