Booth Gillian L, Hux Janet E
Department of Medicine, University of Toronto, Ontario, Canada.
Arch Intern Med. 2003 Jan 13;163(1):101-6. doi: 10.1001/archinte.163.1.101.
Acute diabetic emergencies are potentially avoidable or amenable to timely and effective outpatient therapy.
To evaluate the relationship between socioeconomic status (SES) and acute complications of diabetes mellitus in Ontario.
We used a population-based cohort of persons with diabetes mellitus (N = 605 825) derived from hospital and physician service claims between April 1, 1992, and March 31, 1999. Socioeconomic status was estimated using neighborhood-level data from the 1996 Canadian Census. Outcome events were defined as 1 or more hospitalizations or emergency department visits for hyperglycemia or hypoglycemia.
There was a clear inverse gradient between income level and event rates. Individuals in the lowest income quintile were 44% more likely to have an event than those in the highest quintile (16.4% vs 11.4%; P<.001) and had a greater propensity toward recurrent emergency department admissions (1.9 vs 1.6 episodes per patient; P<.001). The gradient was most marked in 45- to 64-year-olds (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.69-1.82) and less apparent in children (OR, 1.06; 95% CI, 0.99-1.13). The relationship between SES and events persisted after adjusting for age, sex, urban vs rural residence, comorbidity, frequency of physician visits, continuity of care, physician specialty, and geographic region (adjusted OR, 1.09 [95% CI, 1.08-1.10] per quintile level). In contrast, admission rates for non-ambulatory care-sensitive conditions (appendicitis and hip fracture) were unaffected by SES.
Even when some economic barriers to accessing care are removed, patients from low-SES neighborhoods still experience an excess number of hospitalizations for conditions that should be prevented by optimal care in the ambulatory setting.
急性糖尿病急症有可能避免，或可通过及时有效的门诊治疗得到改善。
评估安大略省社会经济地位（SES）与糖尿病急性并发症之间的关系。
我们使用了一个基于人群的糖尿病患者队列（N = 605825），数据来源于1992年4月1日至1999年3月31日期间的医院和医生服务索赔记录。社会经济地位采用1996年加拿大人口普查的社区层面数据进行评估。结局事件定义为因高血糖或低血糖而进行1次或多次住院治疗或急诊就诊。
收入水平与事件发生率之间存在明显的反向梯度。收入最低五分位数的个体发生事件的可能性比收入最高五分位数的个体高44%（16.4%对11.4%；P<0.001），且更倾向于反复急诊入院（每位患者1.9次对1.6次；P<0.001）。这种梯度在45至64岁人群中最为明显（优势比[OR]，1.76；95%置信区间[CI]，1.69 - 1.82），在儿童中则不太明显（OR，1.06；95%CI，0.99 - 1.13）。在调整了年龄、性别、城乡居住情况、合并症、就诊频率、医疗连续性、医生专业和地理区域后，SES与事件之间的关系依然存在（每五分位数水平调整后的OR，1.09 [95%CI，1.08 - 1.10]）。相比之下，非卧床护理敏感疾病（阑尾炎和髋部骨折）的住院率不受SES影响。
即使消除一些获得医疗服务的经济障碍，来自低SES社区的患者因本应在门诊环境中通过最佳护理预防的疾病而住院的人数仍然过多。
