社会经济地位对充血性心力衰竭患者住院再入院的影响：一项前瞻性队列研究。
Impact of socio-economic status on the hospital readmission of Congestive Heart Failure patients: a prospective cohort study.
机构信息
Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. ; Non-Communicable Diseases Research Center, Endocrinology and Metabolism population sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. ; Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
出版信息
Int J Health Policy Manag. 2014 Sep 30;3(5):251-7. doi: 10.15171/ijhpm.2014.94. eCollection 2014 Oct.
BACKGROUND
The aim of this study was to examine the impacts of multiple indicators of Socio-economic Status (SES) on Congestive Heart Failure (CHF) related readmission.
METHODS
A prospective study consisting of 315 patients without the history of admission due to CHF was carried out in Tehran during 2010 and 2011. They were classified into quartiles based on their SES applying Principal Component Analysis (PCA), and followed up for one year. Using stratified Cox regression analysis, Hazard Ratios (HRs) were computed to assess the impact of SES on the readmission due to CHF.
RESULTS
During the 12 months follow-up, 122 (40%) were readmitted at least once. HR of lowest SES patients vs. the highest SES patients (the fourth versus first quartile) was 2.66 (95% CI= 1.51-4.66). Variables including abnormal ejection fraction (<40%), poor physical activity, poor drug adherence, and hypertension were also identified as significant independent predictors of readmission.
CONCLUSION
The results showed low SES is a significant contributing factor to increased readmission due to CHF. It seems that the outcome of CHF depends on the SES of patients even after adjusting for some of main intermediate factors.
背景
本研究旨在探讨多种社会经济地位（SES）指标对充血性心力衰竭（CHF）相关再入院的影响。
方法
2010 年至 2011 年在德黑兰进行了一项前瞻性研究，共纳入 315 例无 CHF 入院史的患者。采用主成分分析（PCA）将患者按 SES 分为四组，并进行为期一年的随访。采用分层 Cox 回归分析，计算风险比（HR）评估 SES 对 CHF 再入院的影响。
结果
在 12 个月的随访期间，有 122 例（40%）至少再入院一次。最低 SES 患者与最高 SES 患者（第四组与第一组）的 HR 为 2.66（95%CI=1.51-4.66）。异常射血分数（<40%）、体力活动差、药物依从性差和高血压等变量也被确定为再入院的显著独立预测因素。
结论
研究结果表明，低 SES 是导致 CHF 再入院率增加的一个重要因素。即使在调整了一些主要中间因素后，CHF 的结局似乎仍取决于患者的 SES。
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