Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Can J Cardiol. 2013 Nov;29(11):1462-9. doi: 10.1016/j.cjca.2013.05.002. Epub 2013 Aug 2.
Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization.
A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension.
The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004.
We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions.
门诊医疗敏感条件（ACSC）的住院治疗代表了社区护理可及性和质量的间接衡量标准。本研究探讨了一种 ACSC（单纯性高血压）的住院率及其相关因素。
使用经过验证的病例定义，通过加拿大四个省在 1997 年至 2004 年的国际疾病分类行政健康数据，定义了患有单纯性高血压的患者队列及其协变量。我们应用加拿大卫生信息研究所的病例定义，以检测所有患有单纯性高血压 ACSC 住院治疗的患者。我们采用逻辑回归评估与单纯性高血压 ACSC 住院治疗相关的因素。
在这四个省份，单纯性高血压的总住院率为每 1000 名高血压患者 3.7 例。调整风险后，城市居民（每 1000 人 2.6 例；95%置信区间 [CI]，2.3-2.7）、收入最高五分位数（每 1000 人 3.4 例；95%CI，2.8-4.2）和无合并症的患者（每 1000 人 3.6 例；95%CI，3.2-3.9）的风险调整率最低。总体而言，纽芬兰的调整后率最高（每 1000 人 5.7 例；95%CI，4.9-6.7），不列颠哥伦比亚省最低（每 1000 人 3.7 例；95%CI，3.4-4.2）。调整后的比率从 1997 年的每 1000 人 5.9 例下降到 2004 年的每 1000 人 3.7 例。
我们发现，单纯性高血压的住院率随着时间的推移呈下降趋势，这可能反映了社区护理的改善。住院率的地理差异表明各省之间以及农村地区之间存在差异。
