Márquez-Calderón S, Rodríguez del Aguila M M, Perea-Milla E, Ortiz J, Bermúdez-Tamayo C
Escuela Andaluza de Salud Pública. Granada. Spain.
Gac Sanit. 2003 Sep-Oct;17(5):360-7. doi: 10.1016/s0213-9111(03)71771-3.
To describe variability in admission rates for ambulatory care sensitive conditions (ASSC) in municipalities in the catchment area of a tertiary hospital and to determine the influence of primary care characteristics, socioeconomic factors, health of the population, and geographical accessibility to the hospital on this variability.
An ecological study was carried out in 34 municipalities in the area served by the Hospital Virgen de las Nieves in Granada (Spain) including all admissions for ASSC from 1997 to 1999. The admission rates for men and women were calculated separately and were age-standardized by the indirect method. The following factors were analyzed as independent variables: characteristics of primary care (type of healthcare model and type of center), socioeconomic factors (unemployment rate, income per capita, number of business establishments, size of municipality), health (mortality rate), and accessibility (time in minutes from the municipality to the hospital). A multiple lineal regression model was estimated.
A total of 9.8% of all hospital admissions were due to ASSC. The mean annual admission rate was 10 admissions per 1.000 inhabitants. This rate was higher for men and for persons aged more than 74 years. The standardized admission ratios were not statistically different from 1 in 56% of the municipalities and were higher than 1 in 26% and lower than 1 in 18%. Sixty-two percent of the variability in rates for men was associated with time taken to reach the hospital, size of municipality, the interaction between both variables, and mortality. Eighteen percent of the variability in rates for women was associated with time taken to reach the hospital and the unemployment rate.
Variability in admission rates for ASSC was not associated with primary care characteristics in the geographical area analyzed. Accessibility (measured as time to the hospital) was the only variable associated with higher rates in both men and women. Admission rates for ASSC among women were higher when unemployment rates were higher, and rates among men were higher in larger municipalities and in those with higher mortality.
描述一家三级医院服务区域内各市政当局门诊护理敏感疾病（ACSC）的住院率差异，并确定初级保健特征、社会经济因素、人口健康状况以及医院的地理可达性对这种差异的影响。
在西班牙格拉纳达的比维斯圣母医院服务区域内的34个市政当局开展了一项生态学研究，纳入了1997年至1999年期间所有ACSC的住院病例。分别计算了男性和女性的住院率，并采用间接法进行年龄标准化。将以下因素作为自变量进行分析：初级保健特征（医疗保健模式类型和中心类型）、社会经济因素（失业率、人均收入、商业机构数量、市政当局规模）、健康状况（死亡率）和可达性（从市政当局到医院的时间，以分钟计）。估计了一个多元线性回归模型。
所有住院病例中，9.8%是由ACSC导致的。年平均住院率为每1000名居民中有10例住院。男性和74岁以上人群的该比率更高。56%的市政当局标准化住院比与1无统计学差异，26%的市政当局高于1，18%的市政当局低于1。男性住院率差异的62%与到达医院的时间、市政当局规模、这两个变量之间的相互作用以及死亡率有关。女性住院率差异的18%与到达医院的时间和失业率有关。
在所分析的地理区域内，ACSC住院率的差异与初级保健特征无关。可达性（以到医院的时间衡量）是与男性和女性较高住院率相关的唯一变量。失业率较高时，女性ACSC的住院率较高，而在规模较大的市政当局以及死亡率较高的市政当局中，男性的住院率较高。
