贫困持续存在及其对手术护理和术后结果的影响
Henrique A Lima1,2, Zorays Moazzam1, Selamawit Woldesenbet1
1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
长期的县级贫困与更糟糕的外科手术结果有关,包括更高的并发症率,再入院,死亡率和成本. 这些由社会经济因素介导的不良影响,不成比例地影响少数群体患者.
科学领域:
- 手术成果研究的研究结果.
- 在健康方面存在差异.
- 健康的社会经济决定因素
背景情况:
- 长期贫困对外科手术结果的影响尚不清楚.
- 贫困是一个复杂的社会决定因素,影响健康和获得医疗保健.
研究的目的:
- 调查县级贫困持续时间与术后结果之间的关联.
- 确定影响贫困和手术成功之间的关系的调解者.
主要方法:
- 对接受重大手术的患者 (2015-2017年) 的医疗保险数据分析 (肺切除,大肠切除,CABG,关节置换).
- 将手术数据与县级贫困数据 (1980-2015) 合并,根据贫困暴露时间对患者进行分类 (从未高贫困与持续贫困).
- 使用后勤回归和结构方程建模来评估结果和介导因素.
主要成果:
- 与从来没有高贫困县的患者相比,持续贫困县的患者面临并发症,30天再入院和死亡率的风险增加.
- 持续的贫困与更高的术后支出有关,并降低了实现教科书结果的几率.
- 社会经济因素介于持续贫困对教科书结果的影响65%;少数群体患者在所有贫困水平上都经历了更糟糕的结果.
结论:
- 县级贫困的持续时间与不良的术后结果和增加的医疗保健成本有显著的相关性.
- 社会经济决定因素在调解贫困对外科结果的负面影响方面发挥着至关重要的作用.
- 由于贫困加剧了手术结果的健康差异,特别是在少数群体中.
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