在家庭医疗保健患者中感染风险的差异:使用区域贫困指数的研究
Jingjing Shang1, Uduwanage Gayani E Perera1, Jianfang Liu1
1Center for Health Policy, Columbia University School of Nursing, New York, NY, USA.
Journal of the American Medical Directors Association
|February 8, 2025
概括
社区贫困与家庭医疗保健患者的感染住院风险更高有关,特别是在偏远的农村地区. 针对性干预对于这些弱势群体至关重要.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 农村卫生 农村卫生
背景情况:
- 邻居的贫困是健康的关键社会决定因素.
- 了解它对在家庭医疗保健 (HHC) 中感染相关住院的影响至关重要,特别是在不同农村级别.
研究的目的:
- 检查邻居贫困和HHC患者感染相关住院之间的关联.
- 分析这些协会在不同级别的农村.
主要方法:
- 对2019年国家医疗保险数据的回顾性分析与区域贫困指数 (ADI) 和农村-城市连续代码 (RUCC) 相关联.
- 包括超过360万名HHC患者,按RUCC分层.
- 使用后勤回归,对共变量进行调整,以评估ADI四分位数和感染入院 (ICD-10代码) 之间的关系.
主要成果:
- 增加的社区贫困与更高比例的双重资格,女性,黑人和西班牙裔患者相关,而白人患者比例较低,特别是在农村环境中.
- 农村地区较高的ADI排名与质量较差的指标和较少的医疗保健资源有关.
- 较高的ADI四分位数显著增加了偏远农村地区的感染风险,但不是在城市地区.
结论:
- 对偏远农村地区存在重大政策和临床影响,需要增加对卫生基础设施,远程医疗和交通的投资.
- 建议对偏远农村地区的医疗保健提供者提供激励措施.
- 该研究表明,需要更敏感的指数来捕捉城市社会经济挑战,因为目前的ADI可能在大都市环境中效果不佳.
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