Laditka James N, Laditka Sarah B
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
Ethn Health. 2006 Aug;11(3):247-63. doi: 10.1080/13557850600565640.
Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension.
We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19-64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence.
Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension.
African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts.
因门诊可治疗疾病而住院（也称为可预防住院）已被广泛视为获得初级卫生保健以及初级卫生保健系统整体成效的一项指标。我们的目的是分别针对六种主要慢性病：心绞痛、哮喘、慢性阻塞性肺疾病、充血性心力衰竭、糖尿病和高血压，研究美国可预防住院与种族和族裔之间的关联。
我们使用了1997年全国住院患者样本、1997年当前人口调查和1997年国家健康访谈调查，来计算非裔美国人、西班牙裔和非西班牙裔白人的可预防住院率以及门诊可治疗疾病的患病率。计算了19 - 64岁以及65岁及以上人群的比率。还估算了考虑到基础住院模式的可预防住院率。最后一组估算对疾病患病率调整了可预防住院率。
几乎在所有情况下，非裔美国人和西班牙裔的可预防住院率均显著高于非西班牙裔白人，无论男女以及两个年龄组都是如此。考虑基础住院模式调整后的比率呈现类似模式。经疾病患病率调整后，男女以及两个年龄组的比率差异仍然显著很大。对于非裔美国人和西班牙裔的男女而言，哮喘、糖尿病和高血压的可预防住院风险尤其高。
即使在考虑疾病患病率和基础医院利用模式之后，非裔美国人和西班牙裔在主要慢性病方面的可预防住院率仍然很高。对于哮喘、糖尿病和高血压这些适合进行预防和管理干预的疾病，这些比率尤其高。我们的结果表明，有必要改善美国非裔美国人和西班牙裔获得优质初级卫生保健的机会，并加强对有针对性预防工作的支持。
