de Koning Lawrence, Henne Dan, Woods Paul, Hemmelgarn Brenda R, Naugler Christopher
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
BMC Health Serv Res. 2014 Aug 9;14:339. doi: 10.1186/1472-6963-14-339.
Increasing laboratory test utilization is a major challenge facing clinical laboratories. However, in most instances we lack population level information on the patient groups to which increased testing is directed. Much recent work has been published on the sociodemographic correlates of 25-hydroxyvitamin D deficiency. An unanswered question, however, is whether testing is preferentially directed towards individuals with a higher likelihood of deficiency. In this paper we examine this question by combining laboratory information system data on testing rates with Census Canada data.
We examined 1,436 census dissemination areas within the city of Calgary, Alberta, Canada. For each census dissemination area we determined age and sex-specific 25-hydroxyvitamin D testing rates over a one year period. We then compared these testing rates with the following sociodemographic variables obtained from Census Canada: first nations status, education level, household income, visible minority status, and recent immigrant status.
Overall, 6.9% of males in the city of Calgary were tested during the study period. Females were 1.7 times more likely to be tested than males. Testing rate increased with increasing age, with 16.8% of individuals 66 years and over tested during the one-year study period. Individuals having at least some university education were less likely to be tested (RR = 0.60; p < 0.0001). Interestingly, although visible minorities were over twice as likely to be tested as compared to non-visual minorities (RR = 2.25; p < 0.0001), recent immigrants, a group known to exhibit low 25 hydroxyvitamin D levels, were significantly less likely to be tested than non-recent immigrants (RR = 0.72; p = 0.0174). While median household income was modestly associated with increased testing (RR = 1.02; p < 0.0001), First Nations status and non-English speaking were not significant predictors of 25-hydroxyvitamin D testing.
Testing for 25-hydroxyvitamin D is in part directed toward populations at higher risk of deficiency (visible minorities) and at higher risk of osteoporosis (older females), but a particularly high risk group (recent immigrants) is being tested at a lower rate than other patient groups.
实验室检测利用率的不断提高是临床实验室面临的一项重大挑战。然而，在大多数情况下，我们缺乏关于接受检测增加的患者群体的总体层面信息。最近有许多关于25-羟基维生素D缺乏症的社会人口统计学相关性的研究发表。然而，一个尚未得到解答的问题是，检测是否优先针对缺乏症可能性较高的个体。在本文中，我们通过将检测率的实验室信息系统数据与加拿大统计局数据相结合来研究这个问题。
我们研究了加拿大艾伯塔省卡尔加里市的1436个人口普查传播区。对于每个人口普查传播区，我们确定了一年期间特定年龄和性别的25-羟基维生素D检测率。然后，我们将这些检测率与从加拿大统计局获得的以下社会人口统计学变量进行比较：原住民身份、教育水平、家庭收入、可见少数群体身份和新移民身份。
总体而言，在研究期间，卡尔加里市6.9%的男性接受了检测。女性接受检测的可能性是男性的1.7倍。检测率随年龄增长而增加，在为期一年的研究期间，66岁及以上的个体中有16.8%接受了检测。至少接受过一些大学教育的个体接受检测的可能性较小（相对风险 = 0.60；p < 0.0001）。有趣的是，尽管可见少数群体接受检测的可能性是非可见少数群体的两倍多（相对风险 = 2.25；p < 0.0001），但新移民（已知25-羟基维生素D水平较低的群体）接受检测的可能性明显低于非新移民（相对风险 = 0.72；p = 0.0174）。虽然家庭收入中位数与检测增加适度相关（相对风险 = 1.02；p < 0.0001），但原住民身份和非英语使用者并不是25-羟基维生素D检测的显著预测因素。
25-羟基维生素D检测部分针对缺乏症风险较高的人群（可见少数群体）和骨质疏松症风险较高的人群（老年女性），但一个特别高风险的群体（新移民）的检测率低于其他患者群体。
