Banta Jim E, Addison Askari, Beeson W Lawrence
School of Public Health, Loma Linda University , CA.
Arizona Department of Health Service , Phoenix, AZ, USA.
J Public Health Res. 2015 Apr 17;4(1):441. doi: 10.4081/jphr.2015.441. eCollection 2015 Feb 20.
Socio-demographic factors are associated with increased emergency department (ED) use among patients with epilepsy. However, there has been limited spatial analysis of such visits.
California ED visit at the patient ZIP Code level were examined using Kulldorf's spatial scan statistic to identify clusters of increased risk for epilepsy-related visits. Logistic regression was used to examine the relative importance of patient socio-demographics, Census-based and hospital measures.
During 2009-2011 there were 29,715,009 ED visits at 330 hospitals, of which 139,235 (0.5%) had epilepsy (International Classification of Disease-9 345.xx) as the primary diagnosis. Three large urban clusters of high epilepsy-related ED visits were centred in the cities of Los Angeles, Oakland and Stockton and a large rural cluster centred in Kern County. No consistent pattern by age, race/ethnicity, household structure, and income was observed among all clusters. Regression found only the Los Angeles cluster significant after adjusting for other measures.
Geospatial analysis within a large and geographically diverse region identified a cluster within its most populous city having an increased risk of ED visits for epilepsy independent of selected socio-demographic and hospital measures. Additional research is necessary to determine whether elevated rates of ED visits represent increased prevalence of epilepsy or an inequitable system of epilepsy care. Significance for public healthThere have been few spatial analyses regarding treatment for epilepsy. This paper significantly expands upon previous work by simultaneously considering multiple urban centres and sparsely populated agricultural and desert/mountain areas in a large state. Furthermore, most epilepsy studies involve one system of care or funding source (such as Department of Veterans Affairs, Medicare, Medicaid, or private insurance plans). This paper considers all funding sources at community-based hospitals. Patient socio-demographics, area-based summaries of socio-demographics, and basic hospital characteristics explain most of the observed spatial variation in rates of emergency department (ED) visits related to epilepsy. However, preliminary spatial analysis demonstrated that an area within downtown Los Angeles did have a higher rate of epilepsy-related visits compared to the rest of the state. A more comprehensive surveillance approach with ED visit data could be readily applied to other large geographic areas and be useful both for on-going monitoring and public health intervention.
社会人口统计学因素与癫痫患者急诊就诊率增加有关。然而，对此类就诊的空间分析有限。
利用库尔道夫空间扫描统计量，在患者邮政编码层面研究加利福尼亚州的急诊就诊情况，以确定癫痫相关就诊风险增加的聚集区。采用逻辑回归分析来检验患者社会人口统计学、基于人口普查和医院指标的相对重要性。
2009 - 2011年期间，330家医院共发生29,715,009次急诊就诊，其中139,235次（0.5%）以癫痫（国际疾病分类第9版345.xx）作为主要诊断。三个与癫痫相关急诊就诊率高的大城市聚集区分别以洛杉矶、奥克兰和斯托克顿市为中心，一个大的农村聚集区以克恩县为中心。在所有聚集区中，未观察到按年龄、种族/族裔、家庭结构和收入呈现的一致模式。回归分析发现，在调整其他指标后，只有洛杉矶聚集区具有统计学意义。
在一个地域广阔且地理环境多样的区域内进行地理空间分析，发现在其人口最多的城市中有一个聚集区，癫痫急诊就诊风险增加，且独立于选定的社会人口统计学和医院指标。需要进一步研究以确定急诊就诊率升高是代表癫痫患病率增加还是癫痫护理系统存在不公平现象。对公共卫生的意义关于癫痫治疗的空间分析很少。本文通过同时考虑一个大州内的多个城市中心以及人口稀少的农业和沙漠/山区，显著扩展了以往的研究工作。此外，大多数癫痫研究涉及一个护理系统或资金来源（如退伍军人事务部、医疗保险、医疗补助或私人保险计划）。本文考虑了社区医院的所有资金来源。患者社会人口统计学、基于区域的社会人口统计学总结以及基本医院特征解释了观察到的与癫痫相关的急诊就诊率的大部分空间差异。然而，初步空间分析表明，洛杉矶市中心的一个区域与该州其他地区相比，癫痫相关就诊率确实更高。一种更全面的利用急诊就诊数据的监测方法可以很容易地应用于其他大地理区域，并且对于持续监测和公共卫生干预都很有用。
