Geissler Kimberley H, Holmes George M
Department of Markets, Public Policy, and Law, Boston University School of Management, Boston, Massachusetts.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Rural Health. 2015 Summer;31(3):316-25. doi: 10.1111/jrh.12109. Epub 2015 Feb 23.
This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial.
We used secondary data from state inpatient and ED discharge databases for California and Arizona for 2005-2010. A retrospective observational analysis using generalized linear models was used to determine whether the probability that an ED encounter was potentially avoidable was associated with homicide rates in the nearest Mexican municipality. To conduct the analysis, the location of ED encounters were identified and matched with homicide rates in the nearest Mexican municipality and regional characteristics. The probability that an ED encounter was potentially avoidable was calculated using the Billings ED algorithm.
We found that 77% of ED encounters were potentially avoidable, with a higher percentage in border counties. There was no statistically significant relationship between homicide rates and the probability that an ED encounter was for a potentially avoidable condition for the full analytic sample (n = 24,859,273) and the uninsured and underinsured in the sample (n = 11,700,123).
A substantial majority of ED encounters in the US-Mexico border region were potentially avoidable. However, there was not a strong relationship between homicide rates in northern Mexico and the distribution of ED discharges in Arizona and California. Given the large percentage of potentially avoidable ED encounters and the ongoing violence in Mexico, continuing to monitor this relationship is important.
本研究评估了墨西哥北部的凶杀率与美国 - 墨西哥边境地区急诊科（ED）潜在可避免的使用情况之间的关联。边境地区大多为农村且医疗服务不足，因此识别和纠正潜在的就医障碍至关重要。
我们使用了2005 - 2010年加利福尼亚州和亚利桑那州的州住院患者和急诊科出院数据库中的二手数据。使用广义线性模型进行回顾性观察分析，以确定急诊科就诊为潜在可避免情况的概率是否与最近墨西哥市的凶杀率相关。为进行分析，确定了急诊科就诊的地点，并将其与最近墨西哥市的凶杀率及区域特征进行匹配。使用比林斯急诊科算法计算急诊科就诊为潜在可避免情况的概率。
我们发现77%的急诊科就诊是潜在可避免的，边境县的比例更高。对于整个分析样本（n = 24,859,273）以及样本中的未参保和参保不足者（n = 11,700,123），凶杀率与急诊科就诊为潜在可避免情况的概率之间没有统计学上的显著关系。
美国 - 墨西哥边境地区的绝大多数急诊科就诊是潜在可避免的。然而，墨西哥北部的凶杀率与亚利桑那州和加利福尼亚州急诊科出院情况的分布之间没有很强的关系。鉴于潜在可避免的急诊科就诊比例很高以及墨西哥持续的暴力状况，持续监测这种关系很重要。
