Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland.
Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland.
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DOI：
10.1016/s2468-2667(18)30068-9
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Gruer L
中科院分区：
文献类型：
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作者：
Katikireddi SV;Cezard G;Bhopal RS;Williams L;Douglas A;Millard A;Steiner M;Buchanan D;Sheikh A;Gruer L
少数民族在获得医疗保健方面常常遇到障碍。我们研究了苏格兰各民族卫生系统绩效的六个既定质量指标。在这项基于人群的队列研究中，我们将苏格兰2001年人口普查（2001年4月29日）的种族与住院和死亡记录联系起来，随访至2013年4月30日。卫生系统绩效的指标包括可避免的死亡（即通过有效治疗可避免的死亡）、可预防的死亡（即通过公共卫生政策可避免的死亡）、可避免的死亡（可避免和可预防的死亡）、可避免的住院、计划外再入院和住院时间。我们使用Poisson和logistic回归计算率比和比值比（95%CI），我们将其乘以100，首先调整年龄相关协变量，然后调整社会经济相关和出生地相关协变量。以苏格兰白色人群为参照（率比[RR] 100）。结果基于461万人。在5050万人年的研究中，发生了117万例可避免的住院，587740例计划外再入院和166245例可避免的死亡。 南亚人群的可避免住院率高于苏格兰白色人群，巴基斯坦人群报告的RR最高（男性RR 140·6 [95% CI 131·9-150·0];女性RR 141·0 [129·0-154·1]）。在住院时间或计划外再入院方面，各种族之间的差异很小。苏格兰白色人组的可接受和可接受死亡率高于其他几个少数民族，包括其他白色英国人、其他白色人、印度人和中国人。这种差异在一定程度上被社会经济地位的调整所削弱，而出生国的调整几乎没有额外的影响。这些数据表明，人们对初级保健的获得和质量表示担忧，以防止可避免的住院，特别是对南亚人。与几个少数民族人口相比，苏格兰白色人的可预防和可处理死亡率相对较高，这是出乎意料的。未来的研究应该证实和检查这些模式的解释。国际上也需要同时使用几个指标的研究。首席科学家办公室，医学研究理事会，苏格兰NHS研究，法尔研究所。
Ethnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland. In this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100). The results are based on 4·61 million people. During the 50·5 million person-years of study, 1·17 million avoidable hospital admissions, 587 740 unplanned readmissions, and 166 245 avoidable deaths occurred. South Asian groups had higher avoidable hospital admissions than the white Scottish group, with the highest reported RRs in Pakistani groups (RR 140·6 [95% CI 131·9–150·0] in men; RR 141·0 [129·0–154·1] in women). There was little variation between ethnic groups in length of stay or unplanned readmission. Preventable and amenable mortality were higher in the white Scottish group than several ethnic minorities including other white British, other white, Indian, and Chinese groups. Such differences were partly diminished by adjustment for socioeconomic status, whereas adjustment for country of birth had little additional effect. These data suggest concerns about the access to and quality of primary care to prevent avoidable hospital admissions, especially for south Asians. Relatively high preventable and amenable deaths in white Scottish people, compared with several ethnic minority populations, were unexpected. Future studies should both corroborate and examine explanations for these patterns. Studies using several indicators simultaneously are also required internationally. Chief Scientist's Office, Medical Research Council, NHS Research Scotland, Farr Institute.