Conway Richard, Byrne Declan, O'Riordan Deirdre, Cournane Seán, Coveney Seamus, Silke Bernard
Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland; CARD Newman Research Fellow, University College Dublin, Belfield, Ireland.
Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
Eur J Intern Med. 2015 Nov;26(9):709-13. doi: 10.1016/j.ejim.2015.09.010. Epub 2015 Sep 26.
Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission; there has been debate as to the extent to which deprivation and population structure influences hospital admission rate.
All emergency medical admissions to an Irish hospital over a 12-year period (2002-2013) categorized by quintile of Deprivation Index and Dependency Ratio (proportion of population <15 or ≥ 65 years) from small area population statistics (SAPS), were evaluated against hospital admission rates. Univariate and multivariable risk estimates (Odds Ratios (OR) or Incidence Rate Ratios (IRR)) were calculated, using logistic or zero truncated Poisson regression as appropriate.
66,861 admissions in 36,214 patients occured during the study period. The Deprivation Index quintile independently predicted the admission rate/1000 population, Q1 9.4 (95%CI 9.2 to 9.7), Q2 16.8 (95%CI 16.6 to 17.0), Q3 33.8 (95%CI 33.5 to 34.1), Q4 29.6 (95%CI 29.3 to 29.8) and Q5 45.4 (95%CI 44.5 to 46.2). Similarly the population Dependency Ratio was an independent predictor of the admission rate with adjusted predicted rates of Q1 20.8 (95%CI 20.5 to 21.1), Q2 19.2 (95%CI 19.0 to 19.4), Q3 27.6 (95%CI 27.3 to 27.9), Q4 43.9 (95%CI 43.5 to 44.4) and Q5 34.4 (95%CI 34.1 to 34.7). A high concurrent Deprivation Index and Dependency Ratio were associated with very high admission rates.
Deprivation Index and population Dependency Ratio are key determinants of the rate of emergency medical admissions.
来自贫困背景的患者在急诊入院后的住院死亡率较高；贫困和人口结构对医院入院率的影响程度一直存在争议。
根据小区域人口统计数据（SAPS）中的贫困指数五分位数和抚养比（15岁以下或65岁及以上人口的比例），对一家爱尔兰医院在12年期间（2002 - 2013年）的所有急诊入院病例进行分类，并与医院入院率进行评估。使用逻辑回归或零截断泊松回归，酌情计算单变量和多变量风险估计值（比值比（OR）或发病率比（IRR））。
在研究期间，36214名患者中有66861例入院。贫困指数五分位数独立预测了每1000人口的入院率，第一五分位数为9.4（95%置信区间9.2至9.7），第二五分位数为16.8（95%置信区间16.6至17.0），第三五分位数为33.8（95%置信区间33.5至34.1），第四五分位数为29.6（95%置信区间29.3至29.8），第五五分位数为45.4（95%置信区间44.5至46.2）。同样，人口抚养比也是入院率的独立预测因素，调整后的预测率第一五分位数为20.8（95%置信区间20.5至21.1），第二五分位数为19.2（95%置信区间19.0至19.4），第三五分位数为27.6（95%置信区间27.3至27.9），第四五分位数为43.9（95%置信区间43.5至44.4），第五五分位数为34.4（95%置信区间34.1至34.7）。高贫困指数和抚养比与非常高的入院率相关。
贫困指数和人口抚养比是急诊入院率的关键决定因素。
