Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study
Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study
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DOI：
10.1016/j.annepidem.2018.11.008
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发表时间：
2019-02-01
影响因子：
5.6
通讯作者：
Hall, Eric S.
中科院分区：
文献类型：
--
作者：
Brokamp, Cole;Beck, Andrew F.;Hall, Eric S.
目的：本研究的目的是进行个人层面的分析，医院利用率在生命的第一年，以检验假设，社区物质匮乏增加卫生保健utilization.Methods：我们使用了一个基于人口的围产期数据库的基础上链接的电子健康记录从区域交付医院随后的医院利用率在该地区唯一的专门儿童医院。零膨胀泊松和考克斯比例风险回归模型被用来量化的因果作用的人口普查区为基础的剥夺指数的总数，长度和时间，直到医院利用在生命的第一年。在调整任何新生儿重症监护室入院、慢性复杂疾病、种族和民族、保险状况、出生季节和极低出生体重后，我们发现，剥夺指数每增加10%，（95%置信区间（CI），[1.025-1.040]），首次住院后的住院时间增加了1.011倍（95% CI，[1.002-1.021]），增加1.022倍（95%CI，[1.009-1.035]）在生命的第一年住院利用的风险。旨在减少物质匮乏和收入不平等的干预措施可以大大减少婴儿医院的使用。(C)2018爱思唯尔公司All rights reserved.
Purpose: The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization.Methods: We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract-based deprivation index on the total number, length, and time until hospital utilization during the first year of life.Results: After adjusting for any neonatal intensive care unit admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight, we found that a 10% increase in the deprivation index caused a 1.032-fold increase (95% confidence interval (CI), [1.025-1.040]) in post initial hospitalization length of stay, a 1.011-fold increase (95% CI, [1.002-1.021]) in number of post initial hospital encounters, and 1.022-fold increase (95% CI, [1.009-1.035]) in hazard for hospitalization utilization during the first year of life.Conclusions: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization. (C) 2018 Elsevier Inc. All rights reserved.