Pirani Monica, Schifano Patrizia, Agabiti Nera, Davoli Marina, Caranci Nicola, Perucci Carlo Alberto
Osservatorio dipendenze patologiche, AUSL Parma.
Epidemiol Prev. 2006 May-Jun;30(3):169-77.
To describe the temporal trend of hospitalisations for Ambulatory Care Sensitive Conditions (ACSCs) from 1997 to 2000 in Bologna (Italy) and to analyze the association with the income level.
We have selected two panels of ACSCs: eight conditions for the paediatric/young population (<20 years of age) and fourteen for the adult population (> or =20 years of age). All discharges for ACSCs of residents in Bologna from Emilia-Romagna hospitals have been selected in the years 1997-2000. An indicator of social position was computed: the median per capita equivalent income by census block, obtained through record linkage between the Italian Tax Register (income earned in 1998) and the Population Register of Bologna.
The direct age-standardized rates and the rate ratio by income level have been calculated. The Poisson regression model has been used to calculate the relative risk (RR) of hospitalizations for ACSCs.
2359 (17.6% of the total) hospitalisations have been selected among the paediatric/young population and 27822 (11.1% of the total) among the adult population. The annual age-adjusted rate of ACSC is 122.68 per 10000 persons among children and 176.60 among adults. The hospitalisation forACSCs among children is associated with a middle-low level of income (RR 1.55; CI 95% 1.35-1.78 for the lowest level vs. highest level), male gender and age <5 years old. In the adult population the risk of hospitalisation for ACSCs is higher among those with lower levels of income (RR 1.80; CI 95% 1.66-1.95 for the lowest level vs. highest level), moreover the RR is higher for men at every age. The admissions forACSCs among adults show a decreasing temporal trend.
The disadvantaged groups of the population experience the highest risk of hospitalisation for ACSCs, with differences by gender and age groups. Although it is difficult to specifically identify the mechanisms potentially involved in the relationship between socioeconomic status and excess of hospitalisation, the admissions for ACSCs may represent an interesting indicator of quality ofprimary care.
描述1997年至2000年意大利博洛尼亚市门诊医疗敏感疾病（ACSCs）的住院时间趋势，并分析其与收入水平的关联。
我们选择了两组ACSCs：针对儿童/青年人群（<20岁）的8种疾病和针对成人人群（≥20岁）的14种疾病。选取了1997 - 2000年期间艾米利亚 - 罗马涅地区医院中博洛尼亚居民ACSCs的所有出院病例。计算了一个社会地位指标：通过意大利税务登记册（1998年所得收入）与博洛尼亚人口登记册之间的记录链接，按普查街区计算的人均等效收入中位数。
计算了直接年龄标准化率和按收入水平划分的率比。采用泊松回归模型计算ACSCs住院的相对风险（RR）。
在儿童/青年人群中选取了2359例住院病例（占总数的17.6%），在成人人群中选取了27822例住院病例（占总数的11.1%）。儿童ACSC的年度年龄调整率为每10000人中有122.68例，成人中为176.60例。儿童ACSCs住院与中低收入水平相关（最低水平与最高水平相比，RR为1.55；95%CI为1.35 - 1.78），与男性性别及年龄<5岁相关。在成人人群中，ACSCs住院风险在收入水平较低者中更高（最低水平与最高水平相比，RR为1.80；95%CI为1.66 - 1.95），此外，各年龄段男性的RR更高。成人ACSCs的入院率呈下降趋势。
弱势群体因ACSCs住院的风险最高，且存在性别和年龄组差异。尽管难以具体确定社会经济地位与住院超额之间潜在关系所涉及的机制，但ACSCs的入院情况可能是初级保健质量的一个有趣指标。
