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作为非英语国家移民对体弱老年住院患者医疗结果的影响:一项澳大利亚研究。

The Impact of Being a Migrant from a Non-English-Speaking Country on Healthcare Outcomes in Frail Older Inpatients: an Australian Study.

作者信息

Basic David, Shanley Chris, Gonzales Rinaldo

机构信息

Department of Geriatric Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.

Centre for Applied Nursing Research, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.

出版信息

J Cross Cult Gerontol. 2017 Dec;32(4):447-460. doi: 10.1007/s10823-017-9333-5.

Abstract

The purpose of this prospective study of 2180 consecutive index admissions to an acute geriatric service was to compare in-hospital outcomes of frail older inpatients born in non-English-speaking counties, referred to as culturally and linguistically diverse (CALD) countries in Australia, with those born in English-speaking countries. Multivariate logistic regression was used to model in-hospital mortality and new nursing home placement. Multivariate Cox proportional hazards regression was used to model length of stay. The mean age of all patients was 83 years and 93% were admitted through the emergency department. In multivariate analyses, patients from CALD and non-CALD backgrounds were equally likely to die (CALD odds ratio [OR] 0.69, 95% confidence interval [95% CI] 0.44-1.10) and be newly placed in a nursing home (OR 0.75, 95% CI 0.51-1.12). Patients from CALD backgrounds unable to speak English were more likely to die (11.5% vs. 7.2%, p = 0.02). While patients from CALD backgrounds had significantly shorter lengths of stay in univariate analysis (median 9 days vs. 10 days, p = 0.02), this was not apparent in multivariate analysis (hazard ratio 1.02, 95% CI 0.91-1.14), where the ability to speak English proved to be a strong confounder. While most of the literature shows poorer outcomes of people from minority ethnic groups, our findings indicate that this is not necessarily the case. Developing culturally appropriate services may mitigate some of the adverse outcomes commonly associated with ethnicity. Our findings are particularly relevant to countries populated by multiple ethnic groups.

摘要

这项前瞻性研究对2180例连续入住急性老年病服务机构的患者进行了分析,旨在比较出生于非英语国家(在澳大利亚被称为文化和语言多元化(CALD)国家)的体弱老年住院患者与出生于英语国家的患者的院内结局。采用多变量逻辑回归对院内死亡率和新入住养老院情况进行建模。采用多变量Cox比例风险回归对住院时间进行建模。所有患者的平均年龄为83岁,93%通过急诊科入院。在多变量分析中,来自CALD和非CALD背景的患者死亡可能性相同(CALD优势比[OR]为0.69,95%置信区间[95%CI]为0.44 - 1.10),新入住养老院的可能性也相同(OR为0.75,95%CI为0.51 - 1.12)。不会说英语的CALD背景患者死亡可能性更高(11.5%对7.2%,p = 0.02)。虽然在单变量分析中,CALD背景患者的住院时间明显更短(中位数9天对10天,p = 0.02),但在多变量分析中并非如此(风险比为1.02,95%CI为0.91 - 1.14),其中说英语的能力被证明是一个强大的混杂因素。虽然大多数文献显示少数族裔人群的结局较差,但我们的研究结果表明情况未必如此。开发适合不同文化的服务可能会减轻一些通常与种族相关的不良结局。我们的研究结果对多民族国家尤为重要。

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