Does geographic access to primary healthcare influence the detection of hepatitis C?
Does geographic access to primary healthcare influence the detection of hepatitis C?
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DOI：
10.1016/j.socscimed.2011.02.015
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发表时间：
2011-05-01
影响因子：
5.4
通讯作者：
Dillon, John F.
中科院分区：
文献类型：
--
作者：
Astell-Burt, Thomas;Flowerdew, Robin;Dillon, John F.
法国最近的研究表明，初级卫生保健的地理条件差可能对丙型肝炎病毒的检出率产生负面影响。地形和基础设施薄弱可能会加剧地理偏远，而围绕丙型肝炎和静脉注射毒品的耻辱感也可能阻碍农村社区寻求保健的行为，因为全科医生的选择有限。在英国没有进行过类似的研究，那里丙型肝炎的检出率也很低。此外，以前的法国研究结果没有调整丙型肝炎流行率和相关风险因素的不均匀空间分布，这增加了报告的旅行时间相关性反映城市地区丙型肝炎流行率较高的可能性（在初级保健的旅行时间很短的地方），而不是地理上获得初级保健的影响。使用地理信息系统，Poisson回归和来自Tayside（苏格兰）的数据集，我们探讨了较低的丙型肝炎检测率是否与初级医疗保健的旅行时间增加有关。我们通过控制一些已知的丙型肝炎感染风险因素的空间变化，测试了一旦模型针对剥夺进行调整，是否仍然存在任何旅行时间效应。单独的模型计算根据病人的阿片类药物替代治疗的历史，考虑到可能已被感染的人通过静脉注射药物use.Rates检测到丙型肝炎最高的男性年龄在25岁至39岁之间。观察到一个统计学上显著的旅行时间衰减效应，尽管在调整剥夺后所有患者都有明显的衰减。进一步的建模确定了旅行时间的影响，只有那些谁接受了阿片替代疗法。在非阿片类药物替代治疗组中没有类似的效应，表明选择效应，而不是因果关系，是最初的旅行时间衰减效应最可能的解释。因此，未来的研究丙型肝炎检测和地理获得初级卫生保健将需要考虑的方法来控制不均匀的空间分布的HCV流行和相关的风险因素超出生态措施的社会经济剥夺。(C)2011爱思唯尔有限公司保留所有权利。
Recent work in France has suggested that poor geographic access to primary healthcare may have a negative influence upon detection rates of the hepatitis C virus. Topography and poor infrastructure can exacerbate geographic remoteness, while the stigma surrounding hepatitis C and intravenous drug use may also discourage healthcare-seeking behaviour in rural communities with limited choice of general practitioner. No similar study has been conducted in the UK, where detection rates of hepatitis C are also low. Moreover, the previous French findings did not adjust for the uneven spatial distribution of HCV prevalence and associated risk factors, which raises the possibility that the reported travel-time associations were a reflection of greater hepatitis C prevalence in urban areas (where the travel-times to primary healthcare are short) and not an effect of geographic access to primary healthcare.Using geographic information systems, Poisson regression and a dataset from Tayside (Scotland), we explored whether lower rates of hepatitis C detection were associated with higher travel-times to primary healthcare. We tested whether any travel-time effects remained once the models were adjusted for deprivation, by controlling for the spatial variation of some of the known risk factors of hepatitis C infection. Separate models were calculated according to patient history of opiate substitution therapy to take account of people likely to have been infected through intravenous drug use.Rates of detected hepatitis C were highest among males aged between 25 and 39 years. A statistically significant travel-time-decay effect was observed, though with notable attenuation for all patients after adjusting for deprivation. Further modelling identified a travel-time effect only for those who had received opiate substitution therapy. The absence of a similar effect in the non-opiate substitution therapy group indicates that selection effects, not causation, are the most likely explanation for the initial travel-time-decay effects. Thus, future studies of hepatitis C detection and geographic access to primary healthcare will need to consider ways of controlling for the uneven spatial distribution of HCV prevalence and associated risk factors beyond ecological measures of socioeconomic deprivation. (C) 2011 Elsevier Ltd. All rights reserved.