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目的由于门诊照护敏感性,原本可门诊治疗的病症,尤其是慢性阻塞性肺疾病(COPD)和哮喘患者,低社会经济状况的个体住院率要更高。此研究对患者人口学、门诊照护利用或医生特征的差异能否用来解释可避免住院治疗的这种差异进行了调查。方法提取加拿大马尼托巴省温尼伯市的住院数据,将年龄18~70岁COPD或哮喘阻塞性呼吸道病患者纳入研究。用家庭均收入法,将患者分入人口普查收入五等分位。控制患者人口学(社会经济状况、年龄、性别及并发症)、门诊照护利用情况(流感疫苗接种和专科医生转诊)以及患者家庭医生的特征(如收费机制、性别和从医年限)协变量后,完成多变量逻辑回归分析,以确定社会经济状况与阻塞性呼吸道疾病住院风险变化有着怎样的关联。结果研究含34 741例阻塞性呼吸道疾病患者:有相关诊断的729例(2.1%)患者2年中有过住院史。与高收入患者相比,低收入患者更有可能采取住院治疗。控制其他变量后,此社会经济状况依照未发现有实质上的变化。全校正模式下,与最高五等分位的患者比较,最低收入五等分位的患者住院概率高出近3倍〔OR=2.93,95%CI(2.19,3.93)〕。结论在普遍的医疗保健领域内,用住院数据测量的门诊照护利用直接相关因素,并不能用来解释门诊照护敏感的呼吸病症因收入所产生的住院差距。研究提示还需寻找不限于医疗保健系统的更为宽泛的社会健康决定因素,以减少贫困人群患无需住院病症的住院数量。
Objectives Individuals with low socioeconomic status have higher rates of hospitalization due to outpatient care sensitivity and previously outpatient treatment conditions, especially those with COPD and asthma. The study investigated whether differences in patient demographics, outpatient care use, or doctor characteristics could be used to explain this discrepancy that would prevent hospitalization. METHODS: Inpatient data were collected from Winnipeg, Manitoba, Canada, and were included in the study among patients aged 18-70 years with COPD or asthma with obstructive airway disease. Family income law, the patient into the census income quintile. Control covariates of patient demographics (socioeconomic status, age, gender and complications), outpatient care utilization (influenza vaccination and specialist referral) and characteristics of patient family physicians (eg charging mechanism, sex and length of service) After that, multivariate logistic regression analysis was done to determine how socioeconomic status correlates with changes in hospital-acquired risk of obstructive respiratory disease. RESULTS Study of 34 741 patients with obstructive respiratory disease: 729 patients (2.1%) with associated diagnosis had a history of hospitalization at 2 years. Low-income patients are more likely to be hospitalized than high-income patients. After controlling for other variables, the socioeconomic status has not been found to have materially changed. In full-correction mode, the probability of hospitalization was nearly 3-fold higher for those with the lowest quintile quintile (OR = 2.93, 95% CI, 2.19, 3.93) compared with patients with the highest quintile. Conclusions Direct access to outpatient care using direct data measured by inpatient data can not be used to explain the inpatient discrepancy in income due to outpatient care-sensitive respiratory illnesses in the general health care arena. Research suggests that more broad-based social health determinations beyond the health care system need to be sought to reduce the number of hospitalizations in the poor without hospitalization.