Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland.
Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
Eur J Intern Med. 2015 Dec;26(10):766-71. doi: 10.1016/j.ejim.2015.09.019. Epub 2015 Oct 21.
Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission. How deprivation relates to the admission or readmission incidence rates, episode length of stay (LOS) and ancillary resource utilization is less clear.
All emergency medical admissions (66,861 episodes in 36,214 patients) between 2002 and 2013, categorized by quintile of Irish National Deprivation Index were assessed against admission or readmission incidence rates (/1000 local population by electoral division), LOS and utilization of five ancillary services. Univariate and multi-variable risk estimates (odds ratios (OR) or incidence rate ratios (IRR)) were calculated, using truncated Poisson regression.
The deprivation index quintile was strongly correlated with the emergency medical admission rate with IRR (as compared with quintile 1) as follows: Q2 1.99 (95% CI: 1.96, 2.01), Q3 3.45 (95% CI: 3.41, 3.49), Q4 3.27 (95% CI: 3.23, 3.31) and Q5 4.29 (95% CI: 4.23, 4.35). LOS was not influenced by deprivation status; although increasing deprivation resulted in increased utilization of social services (OR 1.04: 95% CI: 1.03, 1.06), with a lower requirement for occupational therapy (OR 0.94: 95% CI: 0.93, 0.96) and speech/language services (OR 0.83: 95% CI: 0.80, 0.86). There was a rather decreased use of ancillary services with increasing deprivation; however, the readmission rate was strongly predicted by deprivation status.
Deprivation status strongly influenced the admission and readmission rates for medical patients admitted as emergencies; however, ancillary resource utilization was not increased. Deprivation index will increase demand on hospital resources due to the aggregate effect on both admission and readmission incidence rates.
在急诊入院后，来自贫困背景的患者住院死亡率更高。贫困与入院或再入院发生率、住院时间（LOS）和辅助资源利用之间的关系尚不清楚。
评估了 2002 年至 2013 年间的所有急诊医疗入院（66861 例，涉及 36214 名患者），根据爱尔兰国家贫困指数五分位数进行分类，并根据各选区的当地人口计算入院或再入院发生率（/1000 人）、LOS 和五种辅助服务的使用情况。使用截断泊松回归计算单变量和多变量风险估计（比值比（OR）或发病率比（IRR））。
贫困指数五分位数与急诊医疗入院率密切相关，IRR（与五分位数 1 相比）如下：Q2 1.99（95%CI：1.96，2.01），Q3 3.45（95%CI：3.41，3.49），Q4 3.27（95%CI：3.23，3.31）和 Q5 4.29（95%CI：4.23，4.35）。LOS 不受贫困状况的影响；尽管贫困程度增加导致社会服务的利用增加（OR 1.04：95%CI：1.03，1.06），但对职业治疗的需求降低（OR 0.94：95%CI：0.93，0.96）和言语/语言服务（OR 0.83：95%CI：0.80，0.86）。随着贫困程度的增加，辅助服务的使用量有所减少；然而，再入院率与贫困状况密切相关。
贫困状况强烈影响作为急诊入院的患者的入院和再入院率；然而，辅助资源的利用并没有增加。由于对入院和再入院发生率的综合影响，贫困指数将增加对医院资源的需求。
