Equality of Treatment for Hip Fracture Irrespective of Regional Differences in Socioeconomic Status: Analysis of Nationwide Hospital Claims Data in Japan
Equality of Treatment for Hip Fracture Irrespective of Regional Differences in Socioeconomic Status: Analysis of Nationwide Hospital Claims Data in Japan
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DOI：
10.1620/tjem.247.161
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发表时间：
2019-03-01
影响因子：
2.2
通讯作者：
Matsuda, Shinya
中科院分区：
文献类型：
--
作者：
Tomioka, Shinichi;Fujino, Yoshihisa;Matsuda, Shinya
尽管各种各样的社会经济地位（SES）和健康结果之间的关系的国际证据，社会经济地位和医疗保健提供者的做法之间的关联知之甚少。我们评估了闭合性髋部骨折患者是否根据其居住地区的SES由医院医生进行不同的治疗。髋部骨折是老年人住院的常见原因，但SES与髋部骨折治疗之间的关系在日本仍不清楚。我们使用了2011年4月至2014年3月的诊断程序组合（DPC）数据库。使用人口普查得出的区域贫困指数（ADI）估计患者居住区的SES。我们进行了一项全国索赔数据的横断面研究，并使用交叉分类多水平模型进行分析。我们使用了两种结果测量：（i）病人是否曾接受手术或接受观察治疗;及（ii）入院后至手术的等候日数。我们确定了1,050家医院收治的95,011名患者。其中，85，480名患者接受了手术。居住区的低SES与接受手术的机会无关（P = 0.15），但与较长的等待时间弱相关（系数，0.03; 95%置信区间，-0.01至0.06; P = 0.08）。最大容许日摄入量（10.4）和最小容许日摄入量（-4.0）之间的等待天数差异很小（0.39天）。研究结果显示，病患居住地区的社会经济地位并不影响髋部骨折手术治疗的决策，但对病患从入院到手术的等待天数有显著的影响。
Despite the wide variety of international evidence on the relationship between the socioeconomic status (SES) and health outcomes, less is known about the association between SES and healthcare provider practices. We assessed whether patients with a closed hip fracture were treated differently by hospital physicians according to the SES of their residential areas in Japan. Hip fracture is a common cause of hospitalization among the elderly, but the relationship between SES and hip fracture treatment remains unknown in Japan. We employed the Diagnosis Procedure Combination (DPC) database from April 2011 to March 2014. SES of the patient's residential area was estimated using Census-derived areal deprivation index (ADI). We performed a cross-sectional study of national claims data and analyzed it using cross classified multilevel models. We used two outcome measures: (i) whether the patient received an operation or was treated by watchful waiting; and (ii) number of waiting days until operation following admission. We identified 95,011 patients admitted to 1,050 hospitals. Of these, 85,480 patients underwent surgery. Low SES of residential areas was not correlated with the chance of undergoing surgery (P = 0.15) but was weakly correlated with longer waiting days (coefficient, 0.03; 95% confidence interval, -0.01 to 0.06; P = 0.08). The difference of waiting days between maximum (10.4) and minimum ADI (-4.0) was marginal (0.39 days). The results indicate the SES of patient's residential area does not affect the decision of surgical treatment for hip fracture and has ignorable impact on waiting days from hospital admission to surgery.