Hoffman Geoffrey J, Rodriguez Hector P
1 Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles , Los Angeles, California.
2 Division of Health Policy and Management, School of Public Health, University of California, Berkeley , Berkeley, California.
Popul Health Manag. 2015 Dec;18(6):437-48. doi: 10.1089/pop.2014.0156. Epub 2015 Apr 28.
The objectives were to assess the associations between fall-related injuries (FRIs) treated in the emergency department (ED) among older adults in California and contextual county-level physical, social, and economic characteristics, and to assess how county-level economic conditions are associated with FRIs when controlling for other county-level factors. Data from 2008 California ED discharge, Medicare Impact File, and County Health Rankings were used. Random effects logistic regression models estimated contextual associations between county-level factors representing economic conditions, the built environment, community safety, access to care, and obesity with patient-level FRI treatment among 1,712,409 older adults, controlling for patient-level and hospital-level characteristics. Patient-level predictors of FRI treatment were consistent with previous studies not accounting for contextual associations. Larger and rural hospitals had higher odds of FRI treatment, while teaching and safety net hospitals had lower odds. Better county economic conditions were associated with greater odds (ß=0.73, P=0.001) and higher county-level obesity were associated with lower odds (ß=-0.37, P=0.004), but safer built environments (ß=-0.31, P=0.38) were not associated with FRI treatment. The magnitude of association between county-level economic conditions and FRI treatment attenuated with the inclusion of county-level obesity rates. FRI treatment was most strongly and consistently related to more favorable county economic conditions, suggesting differences in treatment or preferences for treatment for FRIs among older individuals in communities of varying resource levels. Using population health data on FRIs, policy makers may be able to remove barriers unique to local contexts when implementing falls prevention educational programs and built environment modifications.
研究目的是评估加利福尼亚州老年人在急诊科接受治疗的跌倒相关损伤（FRI）与县级背景下的自然、社会和经济特征之间的关联，并在控制其他县级因素的情况下评估县级经济状况与FRI之间的关联。使用了2008年加利福尼亚州急诊科出院数据、医疗保险影响文件和县级卫生排名数据。随机效应逻辑回归模型估计了代表经济状况、建筑环境、社区安全、医疗服务可及性和肥胖的县级因素与1,712,409名老年人患者层面的FRI治疗之间的背景关联，同时控制了患者层面和医院层面的特征。FRI治疗的患者层面预测因素与之前未考虑背景关联的研究一致。规模较大的农村医院FRI治疗的几率较高，而教学医院和安全网医院的几率较低。更好的县级经济状况与更高的几率相关（β=0.73，P=0.001），县级肥胖率较高与较低的几率相关（β=-0.37，P=0.004），但更安全的建筑环境（β=-0.31，P=0.38）与FRI治疗无关。纳入县级肥胖率后，县级经济状况与FRI治疗之间的关联强度减弱。FRI治疗与更有利的县级经济状况最密切且一致相关，这表明不同资源水平社区的老年人在FRI治疗或治疗偏好上存在差异。利用关于FRI的人群健康数据，政策制定者在实施预防跌倒教育计划和改造建筑环境时，或许能够消除当地特有的障碍。
