在加拿大一个主要城市中心出生的儿童中，社会不平等与非卧床护理敏感型住院之间的关系持续长达9年。

Relationship between social inequalities and ambulatory care-sensitive hospitalizations persists for up to 9 years among children born in a major Canadian urban center.

作者信息

Agha Mohammad M, Glazier Richard H, Guttmann Astrid

机构信息

Centre for Research on Inner City Health, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ambul Pediatr. 2007 May-Jun;7(3):258-62. doi: 10.1016/j.ambp.2007.02.005.

DOI:10.1016/j.ambp.2007.02.005

PMID:17512888

Abstract

OBJECTIVE

Hospitalizations for ambulatory care-sensitive (ACS) conditions have been considered a marker for access to timely and effective primary care, but there are few pediatric studies. Our purpose was to examine socioeconomic disparities in ACS and non-ACS admissions among birth cohorts in a universal health insurance setting.

METHODS

We examined ACS and all hospitalizations of children born from 1993 to 2000 in Toronto, Canada, by birth year, calendar year, and socioeconomic status (SES). SES was evaluated by using quintiles of mean neighborhood income from the 1996 Canadian census. Cohort, age, and temporal effects were described for all admissions, ACS admissions, and specific ACS conditions. Attributable risk by SES was calculated by using rates for the highest and lowest SES quintiles.

RESULTS

Among 255,284 children born in Toronto during 1993-2001, ACS conditions were responsible for 28% of hospitalizations during the first 2 years of life and close to half of admissions during the third year. Low income was associated with 50% higher rates of ACS hospitalizations (relative risk [RR] = 1.50, 95% confidence interval [95% CI] 1.43-1.58), including asthma (RR = 1.69, 95% CI 1.54-1.86) and bacterial pneumonia (RR = 1.59, 95% CI 1.40-1.81), the leading causes of admission. Socioeconomic disparities in ACS and all admissions occurred in every cohort, every calendar year, and every age group.

CONCLUSIONS

The relationship between socioeconomic disadvantage and both ACS and all-cause hospitalization in children was large, consistent across many conditions, remained stable over time, and persisted up to 9 years of age. These effects occurred in a universal health insurance setting without direct financial barriers to physician or hospital care. The effect of SES on hospitalizations in children in our setting appears to be mediated by factors other than financial access to care.

摘要

目的

门诊医疗敏感型（ACS）疾病的住院治疗被视为获得及时有效初级医疗服务的一个标志，但儿科研究较少。我们的目的是在全民医疗保险环境下，研究出生队列中ACS和非ACS入院情况的社会经济差异。

方法

我们按出生年份、日历年和社会经济地位（SES），对1993年至2000年在加拿大多伦多出生的儿童的ACS和所有住院情况进行了研究。SES通过使用1996年加拿大人口普查中邻里平均收入的五分位数来评估。对所有入院情况、ACS入院情况和特定的ACS疾病描述了队列、年龄和时间效应。通过使用最高和最低SES五分位数的发病率计算SES的归因风险。

结果

在1993 - 2001年期间在多伦多出生的255,284名儿童中，ACS疾病导致了出生后头两年28%的住院治疗以及第三年近一半的入院治疗。低收入与ACS住院率高50%相关（相对风险[RR]=1.50，95%置信区间[95%CI]1.43 - 1.58），包括哮喘（RR = 1.69，95%CI 1.54 - 1.86）和细菌性肺炎（RR = 1.59，95%CI 1.40 - 1.81），这两种是主要的入院原因。ACS和所有入院情况的社会经济差异在每个队列、每个日历年和每个年龄组中都存在。