Hale Nathan, Probst Janice, Robertson Ashley
Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Box 70264, Johnson City, TN, 37614, USA.
Department of Health Services Policy and Management, South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC, 29208, USA.
J Community Health. 2016 Jun;41(3):451-60. doi: 10.1007/s10900-015-0113-2.
This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (<18 years of age) from 2011. One state from each of the nine US census regions with substantial rural representation and varying degrees of community vulnerability was selected. An area deprivation index was constructed and used in conjunction with rurality to examine differences in the rate of ACSC hospitalizations among children in the sample states. A mixed model with both fixed and random effects was used to test influence of rurality and area deprivation on the odds of a pediatric hospitalization due to an ACSC within the sample. Of primary interest was the interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes.
本研究利用2011年来自9个州的18岁以下儿童住院患者样本，考察了农村地区与社区贫困程度的交叉情况。从美国9个普查区域中各选取一个州，这些州有大量农村人口，且社区脆弱程度各异。构建了一个地区贫困指数，并将其与农村地区情况结合起来，以考察样本州儿童中因可避免的医疗服务利用不当（ACSC）导致的住院率差异。使用一个包含固定效应和随机效应的混合模型，来检验农村地区和地区贫困程度对样本中因ACSC导致儿科住院几率的影响。主要关注的是农村地区与地区贫困程度的相互作用。研究发现，在最贫困地区中，农村县的占比过高。在最不贫困的县中，农村地区因ACSC住院的可能性显著低于城市地区。然而，随着贫困程度的增加，这种农村优势逐渐减弱，这表明随着社会和经济优势的恶化，农村地区的影响变得更加重要。我们还发现，在种族/族裔少数群体儿童以及预期支付来源为医疗补助或自费的儿童中，因ACSC住院的情况要多得多。这些发现进一步丰富了现有证据，证明了在重要的健康相关结果方面存在种族/族裔差异。
