Philbin E F, Dec G W, Jenkins P L, DiSalvo T G
Division of Cardiology, Albany Medical College, Albany, New York 12208, USA.
Am J Cardiol. 2001 Jun 15;87(12):1367-71. doi: 10.1016/s0002-9149(01)01554-5.
The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square test for trend across all quartiles; p <0.0001 for comparison between quartiles 1 and 4). After adjustment for baseline differences and process of care, income remained a significant predictor, with an increase in the risk of readmission noted in association with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18; 95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients hospitalized for treatment of heart failure in New York differ from higher income patients in important clinical and demographic comparisons. Even after adjustment for these fundamental differences and other potential confounding factors, lower income is a positive predictor of readmission risk.
心力衰竭的管理特点是住院率以及该疾病住院治疗后的再住院率都很高，而精湛的医疗护理可能会降低住院风险。本研究的目的是在一大群接受心力衰竭治疗的不同人群中，研究收入（作为社会经济地位的衡量指标）与再次入院频率之间的关系。我们分析了纽约州236家非联邦急症护理医院的行政出院数据，这些数据涉及1995年1月1日至12月31日期间在主要诊断位置有国际疾病分类第九版临床修订本心力衰竭编码的41776名非裔美国人或白人医院幸存者。家庭收入来自邮政邮政编码和人口普查数据。我们发现，居住在低收入社区的患者更多为女性或非裔美国人，有更多合并症，更多使用医疗补助保险，并且更常入住农村医院。再入院的粗频率从收入最低四分位数（23.2%）到最高四分位数（20.0%）呈逐步下降（所有四分位数趋势的Mantel-Haenszel卡方检验p<0.0001；四分位数1和4之间比较p<0.0001）。在对基线差异和护理过程进行调整后，收入仍然是一个显著的预测因素，收入水平较低与再入院风险增加相关（四分位数1:4比较的调整优势比为1.18；95%置信区间为1.10至1.26，p<0.0001）。我们得出结论，在纽约因心力衰竭住院治疗的低收入患者在重要的临床和人口统计学比较方面与高收入患者不同。即使在对这些基本差异和其他潜在混杂因素进行调整后，低收入仍是再入院风险的正向预测因素。
