社会经济地位与基于严重程度的中毒发生率：一项全国性队列研究。

Socioeconomic status and severity-based incidence of poisoning: a nationwide cohort study.

作者信息

Song Kyoung Jun, Shin Sang Do, Cone David C

机构信息

Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

出版信息

Clin Toxicol (Phila). 2009 Sep;47(8):818-26. doi: 10.1080/15563650903158870.

DOI:10.1080/15563650903158870

PMID:19640232

Abstract

BACKGROUND

The association between severity-based incidence of poisoning and socioeconomic status (SES) was investigated.

METHODS

SES was classified based on the premium level of the National Health Insurance cohort, which are medical aid (MA) population not requiring a premium, five self-employed insured (SEI) population groups, and five employed insured (EI) population groups. The poisoning data sets were obtained from the National Injury Database (2001-2003) of Korea. Severity-based standardized incidence rates (SIRs) were calculated using an excess mortality ratio-adjusted injury severity score (EMR-ISS) similar to the new ISS. EMR-ISS was used to categorize poisoning severity as mild (1 < or = EMR-ISS < or = 8), moderate (10 < or = EMR-ISS < or = 24), severe (25 < or = EMR-ISS < or = 74), or critical (EMR-ISS = 75 or death). The association of household-level SES and severity-based incidence was evaluated using a multiple Poisson regression model with adjustment for the urbanization level and seasonal variations.

RESULTS

The total number of poisoning patients was 83,378. The SIR was 1,584 per 1 million person-years. Critical, severe, moderate, and mild poisoning rates were 16.3, 56.7, 18.7, and 8.3%, respectively. SIRs and relative risks of moderate to critical injuries in the SEI group and of moderate (9 < or = EMR-ISS < 25) injuries in the EI group were strongly and inversely associated with the SES level when compared with MA. When we used the multiple Poisson regression model using the MA group as a reference, adjusted rate ratios were 0.97 (95% confidence interval, 0.94-1.01) for greater than severe poisoning and 0.75 (95% confidence interval, 0.69-0.82) for critical poisoning in the highest SEI. A strong inverse association was found between adjusted incidence of critical poisoning and SEI and EI levels.

CONCLUSION

A strong association between SES levels and severity-based incidence was found in a large nationwide cohort of poisonings.

摘要

背景

研究了基于严重程度的中毒发病率与社会经济地位（SES）之间的关联。

方法

根据国民健康保险队列的保费水平对SES进行分类，即无需缴纳保费的医疗救助（MA）人群、五个个体经营参保（SEI）人群组和五个就业参保（EI）人群组。中毒数据集来自韩国国家伤害数据库（2001 - 2003年）。使用类似于新损伤严重度评分（ISS）的超额死亡率调整损伤严重度评分（EMR - ISS）计算基于严重程度的标准化发病率（SIR）。EMR - ISS用于将中毒严重程度分为轻度（1≤EMR - ISS≤8）、中度（10≤EMR - ISS≤24）、重度（25≤EMR - ISS≤74）或极重度（EMR - ISS = 75或死亡）。使用多泊松回归模型评估家庭层面的SES与基于严重程度的发病率之间的关联，并对城市化水平和季节变化进行调整。

结果

中毒患者总数为83378例。SIR为每100万人年1584例。极重度、重度、中度和轻度中毒率分别为16.3%、56.7%、18.7%和8.3%。与MA组相比，SEI组中重度至极重度损伤的SIR和相对风险以及EI组中中度（9≤EMR - ISS＜25）损伤的SIR和相对风险与SES水平呈强烈负相关。当以MA组为参照使用多泊松回归模型时，最高SEI组中重度以上中毒的调整率比为0.97（95%置信区间，0.94 - 1.01），极重度中毒的调整率比为0.75（95%置信区间，0.69 - 0.82）。在极重度中毒的调整发病率与SEI和EI水平之间发现了强烈的负相关。