儿童体外膜氧化利用的社会决定因素:一个多中心的回顾性队列研究
Faraz Alizadeh1, Kimberlee Gauvreau1, Jessica A Barreto1
1Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
The Lancet. Child & adolescent health
|June 29, 2025
概括
健康影响的社会决定因素 身体外膜氧化 (ECMO) 在重症儿童中的使用. 来自较低社会经济背景,少数群体和公共保险的儿童使用ECMO的比例较低,这表明健康差异.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 卫生公平研究 卫生公平研究
- 健康的社会决定因素
背景情况:
- 健康的社会决定因素显著影响医疗保健的获取和决策.
- 了解这些因素对于改善患者治疗结果至关重要.
- 本研究研究了社会决定因素对儿童体外膜氧化 (ECMO) 的使用的影响.
研究的目的:
- 分析儿童患者体外膜氧化 (ECMO) 的利用情况.
- 检查健康的社会决定因素如何影响ECMO的使用和结果.
- 确定儿童在ECMO获取和应用方面的差异.
主要方法:
- 针对47家美国儿童医院的重症监护病房的儿童 (<18岁) 进行了回顾性多中心队列研究 (2015年10月至2021年3月).
- 纳入标准:与心脏或呼吸系统诊断的极端/重大死亡风险.
- 分析了社会决定因素,包括儿童机会指数 (COI),种族,种族,保险类型,到医院的距离和使用多变量多项回归的地区.
主要成果:
- 在309,937名符合条件的儿童中,2.8%接受了ECMO,4.0%没有ECMO死亡,93.2%没有ECMO生存.
- 较低的儿童机会指数 (COI) 分数与没有ECMO的死亡风险更高有关 (每10个点的下降1.05的aRRR).
- 在亚洲/其他种族,西班牙裔种族和公共保险团体中观察到没有ECMO的死亡风险增加. 还注意到了基于区域和距离的差异.
结论:
- 基于健康的社会决定因素,ECMO的使用存在显著差异.
- 来自贫困社区,少数民族背景和公共保险的儿童使用ECMO的比例较低.
- 卫生公平框架对于制定促进公平使用ECMO的干预措施至关重要.
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