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美国败血症死亡率的社会决定因素:回顾性流行病学分析
Ahad Khaleghi Ardabili1,2, Alireza Vafaei Sadr2,3, Vida Abedi2,3
1Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17036, USA.
medRxiv : the preprint server for health sciences
|January 7, 2025
概括
邻居健康的社会决定因素,如收入和公园入口,显著影响败血症死亡率. 解决这些因素对于改善患者的结果和减少健康差异至关重要.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 败血症是美国死亡的主要原因之一.
- 健康的社会决定因素 (SDoH) 越来越多地被认为是影响健康结果的关键因素.
- 社区级SDoH对败血症死亡率的影响仍未得到充分研究.
研究的目的:
- 调查邻居健康社会决定因素 (SDoH) 与美国败血症患者死亡率之间的关联.
- 确定特定的SDoH,预测与败血症相关的死亡率.
- 为旨在减少败血症差异的公共卫生干预提供信息.
主要方法:
- 来自TriNetX钻石网络的440万名败血症患者记录的回顾性分析.
- 包括SDoH变量,如收入,住房成本负担,宽带接入,公园附近,种族/民族多样性和区域贫困指数 (ADI).
- 统计建模包括单变量和多变量二项式通用线性模型,不包括多线性预测器.
主要成果:
- 较低的收入,较高的ADI,有限的公园接入和缺乏宽带与增加的败血症死亡率有关.
- 较大的种族/民族多样性与死亡率有负面关联.
- 通过随机森林分析,公园进入成为败血症死亡率的最重要的预测因素.
结论:
- 社区级SDoH对于败血症风险分层和预后模型至关重要.
- 将SDoH整合到预测框架中是改善败血症护理的必要条件.
- 需要有针对性的干预措施来解决社会脆弱性和获得资源的机会,以减轻败血症结果差异.
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