University of California, San Francisco, CA 94143, USA.
Arthritis Care Res (Hoboken). 2010 Jun;62(6):888-95. doi: 10.1002/acr.20125.
To examine the effects of individual and local level socioeconomic status (SES) and health care access characteristics on the number of self-report physician visits for systemic lupus erythematosus (SLE).
Data derived from 755 adult participants from the 2004 to 2007 Lupus Outcomes Study (LOS) resulted in a sample of 2,926 repeated-measures observations. The outcome measure was the number of physician visits in the prior 12 months. Information on disease activity and manifestations, demographics, health insurance, and specialty of the participants' main SLE physician was collected through yearly LOS interviews. Local area measures including neighborhood poverty, the number of subspecialists per capita, and hospital market areas were added from secondary data sources. We used a mixed model with repeated measures to estimate the number of physician visits for SLE by SES and health care access characteristics, as well as the extent of concentrated poverty and number of subspecialists per capita in the local community, and whether these relationships varied by specific hospital market area. Multivariate models were adjusted for demographic and health status covariates.
LOS respondents reported a mean +/- SD of 11.8 +/- 10.7 (range 0-52) physician visits for SLE. After adjustment, having less than a high school education, receiving care in a health maintenance organization, being treated by a generalist, and living in a community of concentrated poverty were associated with a significantly lower number of physician visits for SLE. These relationships varied by hospital market areas.
Beyond health status, the number of physician visits for SLE varies by SES, neighborhood poverty, and characteristics of the health care system.
研究个体和社区社会经济地位（SES）以及医疗保健获取特征对系统性红斑狼疮（SLE）患者自报就诊次数的影响。
数据来源于 2004 年至 2007 年狼疮结局研究（LOS）的 755 名成年参与者，共产生 2926 次重复测量观察结果。因变量为过去 12 个月内的就诊次数。通过每年进行的 LOS 访谈，收集参与者的疾病活动和表现、人口统计学、医疗保险以及主要 SLE 医生的专业信息。通过二级数据来源获取社区贫困率、每千人的专科医生数量和医院市场区域等局部区域指标。我们采用混合模型进行重复测量，以评估 SES 和医疗保健获取特征对 SLE 就诊次数的影响，以及社区集中贫困程度和每千人的专科医生数量，以及这些关系是否因特定医院市场区域而异。多变量模型调整了人口统计学和健康状况的协变量。
LOS 受访者报告的 SLE 平均就诊次数为 11.8 +/- 10.7（范围 0-52）。调整后，受教育程度低于高中、接受健康维护组织的护理、由全科医生治疗以及生活在集中贫困社区与 SLE 就诊次数显著减少相关。这些关系因医院市场区域而异。
除健康状况外，SLE 的就诊次数还因 SES、社区贫困程度和医疗保健系统的特征而异。
