Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England.
Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England.
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共同199年大流行的可避免住院的不平等趋势：英格兰2350万人的队列研究。
DOI：
10.1136/bmjopen-2023-077948
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发表时间：
2024-01-08
期刊：
影响因子：
2.9
通讯作者：
Katikireddi, Srinivasa Vittal
中科院分区：
文献类型：
--
作者：
Green, Mark Alan;McKee, Martin;Massey, Jon;Mackenna, Brian;Mehrkar, Amir;Bacon, Seb;Macleod, John;Sheikh, Aziz;Shah, Syed Ahmar;Katikireddi, Srinivasa Vittal
确定在英格兰，混乱时期是否与“可避免的”住院人数增加以及更广泛的社会不平等相关。
观察性重复横断面研究。
英格兰（2019年1月至2022年3月）。
经英国国家医疗服务体系（NHS）批准，我们使用了来自OpenSAFELY的个体层面电子健康记录，其涵盖了英格兰约40%的全科诊所（平均每月人口规模为2350万人）。
我们估算了潜在可预防的非计划性住院的粗略和直接年龄标准化比率：门诊敏感疾病和急诊敏感疾病。我们考虑了这些结果的趋势如何因社会和空间不平等的三个衡量标准而变化：社区社会经济剥夺程度、种族和地理区域。
在第一次全国封锁期间（2020年3月至5月），可避免的住院人数大幅下降。封锁后趋势上升，但从未达到2019年的水平。这些趋势的例外情况是疫苗可预防的门诊敏感疾病住院人数，在2020 - 2021年期间一直保持在较低水平。虽然每种不平等衡量标准下的趋势是一致的，但社区社会经济剥夺程度、亚洲种族（与白人种族相比）和地理区域（特别是北部地区）之间的不平等绝对水平有所缩小。
我们没有发现证据表明新冠疫情导致的医疗保健中断时期造成了更多可避免的住院情况。可避免的住院人数下降与不平等程度下降同时发生，按剥夺程度衡量最为明显，在亚洲族裔群体和英格兰北部地区也是如此。
To determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England. Observational repeated cross-sectional study. England (January 2019 to March 2022). With the approval of NHS England we used individual-level electronic health records from OpenSAFELY, which covered ~40% of general practices in England (mean monthly population size 23.5 million people). We estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity and geographical region. There were large declines in avoidable hospitalisations during the first national lockdown (March to May 2020). Trends increased post-lockdown but never reached 2019 levels. The exception to these trends was for vaccine-preventable ambulatory care sensitive admissions which remained low throughout 2020–2021. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed across levels of neighbourhood socioeconomic deprivation, Asian ethnicity (compared with white ethnicity) and geographical region (especially in northern regions). We found no evidence that periods of healthcare disruption from the COVID-19 pandemic resulted in more avoidable hospitalisations. Falling avoidable hospital admissions has coincided with declining inequalities most strongly by level of deprivation, but also for Asian ethnic groups and northern regions of England.
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影响因子：
16.6
作者：
Huang QS;Wood T;Jelley L;Jennings T;Jefferies S;Daniells K;Nesdale A;Dowell T;Turner N;Campbell-Stokes P;Balm M;Dobinson HC;Grant CC;James S;Aminisani N;Ralston J;Gunn W;Bocacao J;Danielewicz J;Moncrieff T;McNeill A;Lopez L;Waite B;Kiedrzynski T;Schrader H;Gray R;Cook K;Currin D;Engelbrecht C;Tapurau W;Emmerton L;Martin M;Baker MG;Taylor S;Trenholme A;Wong C;Lawrence S;McArthur C;Stanley A;Roberts S;Rahnama F;Bennett J;Mansell C;Dilcher M;Werno A;Grant J;van der Linden A;Youngblood B;Thomas PG;NPIsImpactOnFlu Consortium;Webby RJ
通讯作者：
Webby RJ
影响因子：
105.7
作者：
Green, Mark A.;McKee, Martin;Hamilton, Olivia K. L.;Shaw, Richard J.;Macleod, John;Boyd, Andy;Katikireddi, Srinivasa Vittal
通讯作者：
Katikireddi, Srinivasa Vittal
影响因子：
4.4
作者：
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通讯作者：
Olsen SJ
影响因子：
13.8
作者：
Abe, Kazuhiro;Kawachi, Ichiro;Iba, Arisa;Miyawaki, Atsushi
通讯作者：
Miyawaki, Atsushi
影响因子：
3.7
作者：
Green, Mark A.;Hungerford, Daniel J.;Hughes, David M.;Garcia-Finana, Marta;Turtle, Lance;Cheyne, Christopher;Ashton, Matthew;Leeming, Gary;Semple, Malcolm G.;Singleton, Alex;Buchan, Iain
通讯作者：
Buchan, Iain