美国佐治亚州亚特兰大市部分医院的社会经济地位与非致命性成人伤害情况

Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals.

作者信息

Hulland Erin, Chowdhury Ritam, Sarnat Stefanie, Chang Howard H, Steenland Kyle

机构信息

1Department of Biostatistics and Bioinformatics,Rollins School of Public Health,Emory University,Atlanta,GeorgiaUSA.

2Department of Epidemiology,James T. Laney School of Graduate Studies,Emory University,Atlanta,GeorgiaUSA.

出版信息

Prehosp Disaster Med. 2017 Aug;32(4):403-413. doi: 10.1017/S1049023X17000255. Epub 2017 Mar 31.

DOI:10.1017/S1049023X17000255

PMID:28359343

Abstract

BACKGROUND

Injury mortality data for adults in the United States and other countries consistently show higher mortality for those with lower socioeconomic status (SES). Data are sparse regarding the role of SES among adult, non-fatal US injuries. The current study estimated non-fatal injury risk by household income using hospital emergency department (ED) visits.

METHODS

A total of 1,308,892 ED visits at 10 Atlanta (Georgia USA) hospitals from 2001-2004 (347,866 injuries) were studied. The SES was based on US census-block group income, with subjects assigned to census blocks based on reported residence. Logistic regression was used to determine risk by SES for injuries versus all other ED visits, adjusting for demographics, hospital, and weather. Supplemental analyses using hospital data from 2010-2013, without data on SES, were conducted to determine whether earlier patterns by race, age, and gender persisted.

RESULTS

Risk for many injury categories increased with higher income. Odds ratio by quartiles of increasing income (lowest quartile as referent, 95% confidence interval [CI] given for upper most quartile) were 1.00, 1.23, 1.34, 1.40 (95% CI 1.36-1.45) for motor vehicle accidents; 1.00, 1.03, 1.11, 1.24 (95% CI 1.20-1.29) for being struck by objects; 1.00. 0.99, 1.04, 1.12 (95% CI 1.00-1.25) for suicide; and 1.00, 1.03, 1.05, 1.12 (95% CI 1.09-1.15) for falls. In contrast, decreased injury risk with increased household income was seen for assaults (1.00, 0.83, 0.73, 0.67 [95% CI 0.63-0.72], by increasing quartiles). These trends by income did not differ markedly by race and gender. Whites generally had less risk of injuries, with the exception of assaults and motor vehicle accidents. Males had higher risk of injury than females, with the exception of falls and suicide attempts. Patterns of risk for race, age, and gender were consistent between 2001-2004 and 2010-2013.

CONCLUSION

For most non-fatal injuries, those with higher income had more risk of ED visits, although the opposite was true for assault. Hulland E , Chowdhury R , Sarnat S , Chang HH , Steenland K . Socioeconomic status and non-fatal adult injuries in selected Atlanta (Georgia USA) hospitals. Prehosp Disaster Med. 2017;32(4):403-413.

摘要

背景

美国及其他国家的成人伤害死亡率数据始终表明，社会经济地位（SES）较低者的死亡率更高。关于SES在美国成人非致命伤害中的作用的数据较为稀少。当前研究利用医院急诊科就诊情况，按家庭收入估算非致命伤害风险。

方法

对2001年至2004年美国佐治亚州亚特兰大市10家医院的1308892次急诊科就诊（347866例伤害）进行了研究。SES基于美国人口普查街区组收入，根据报告的居住地将研究对象分配到人口普查街区。采用逻辑回归分析，在对人口统计学、医院和天气因素进行校正后，确定SES与伤害就诊相比所有其他急诊科就诊的风险。利用2010年至2013年的医院数据进行补充分析（无SES数据），以确定种族、年龄和性别方面的早期模式是否持续存在。

结果

许多伤害类别的风险随收入增加而升高。按收入四分位数（以最低四分位数为参照，给出最高四分位数的95%置信区间[CI]）计算的优势比，机动车事故为1.00、1.23、1.34、1.40（95%CI 1.36 - 1.45）；被物体击中为1.00、1.03、1.11、1.24（95%CI 1.20 - 1.29）；自杀为1.00、0.99、1.04、1.12（95%CI 1.00 - 1.25）；跌倒为1.00、1.03、1.05、1.12（95%CI 1.09 - 1.15）。相比之下，攻击伤（按收入四分位数增加分别为1.00、0.83、0.73、0.67[95%CI 0.63 - 0.72]）的伤害风险随家庭收入增加而降低。这些收入相关趋势在种族和性别方面无明显差异。白人一般伤害风险较低，但攻击伤和机动车事故除外。男性伤害风险高于女性，但跌倒和自杀未遂除外。2001年至2004年与2010年至2013年期间，种族、年龄和性别的风险模式一致。