Nkoy Flory L, Stone Bryan L, Knighton Andrew J, Fassl Bernhard A, Johnson Joseph M, Maloney Christopher G, Savitz Lucy A
Division of Pediatric Inpatient Medicine, University of Utah, Salt Lake City, Utah;
Division of Pediatric Inpatient Medicine, University of Utah, Salt Lake City, Utah.
Hosp Pediatr. 2018 Jan 9. doi: 10.1542/hpeds.2017-0032.
Collecting social determinants data is challenging. We assigned patients a neighborhood-level social determinant measure, the area of deprivation index (ADI), by using census data. We then assessed the association between neighborhood deprivation and asthma hospitalization outcomes and tested the influence of insurance coverage.
A retrospective cohort study of children 2 to 17 years old admitted for asthma at 8 hospitals. An administrative database was used to collect patient data, including hospitalization outcomes and neighborhood deprivation status (ADI scores), which were grouped into quintiles (ADI 1, the least deprived neighborhoods; ADI 5, the most deprived neighborhoods). We used multivariable models, adjusting for covariates, to assess the associations and added a neighborhood deprivation status and insurance coverage interaction term.
A total of 2270 children (median age 5 years; 40.6% girls) were admitted for asthma. We noted that higher ADI quintiles were associated with greater length of stay, higher cost, and more asthma readmissions ( < .05 for most quintiles). Having public insurance was independently associated with greater length of stay (β: 1.171; 95% confidence interval [CI]: 1.117-1.228; < .001), higher cost (β: 1.147; 95% CI: 1.093-1.203; < .001), and higher readmission odds (odds ratio: 1.81; 95% CI: 1.46-2.24; < .001). There was a significant deprivation-insurance effect modification, with public insurance associated with worse outcomes and private insurance with better outcomes across ADI quintiles ( < .05 for most combinations).
Neighborhood-level ADI measure is associated with asthma hospitalization outcomes. However, insurance coverage modifies this relationship and needs to be considered when using the ADI to identify and address health care disparities.
收集社会决定因素数据具有挑战性。我们利用人口普查数据为患者分配了一个邻里层面的社会决定因素指标，即贫困指数（ADI）。然后，我们评估了邻里贫困与哮喘住院结局之间的关联，并检验了保险覆盖范围的影响。
对8家医院收治的2至17岁哮喘儿童进行回顾性队列研究。使用行政数据库收集患者数据，包括住院结局和邻里贫困状况（ADI评分），并将其分为五等份（ADI 1为最不贫困的邻里；ADI 5为最贫困的邻里）。我们使用多变量模型，对协变量进行调整，以评估关联，并添加了邻里贫困状况和保险覆盖范围的交互项。
共有2270名儿童（中位年龄5岁；40.6%为女孩）因哮喘住院。我们注意到，ADI五等份越高，住院时间越长、费用越高、哮喘再入院率越高（大多数五等份的P<0.05）。拥有公共保险与住院时间更长（β：1.171；95%置信区间[CI]：1.117-1.228；P<0.001）、费用更高（β：1.147；95%CI：1.093-1.203；P<0.001）以及再入院几率更高（优势比：1.81；95%CI：1.46-2.24；P<0.001）独立相关。存在显著的贫困-保险效应修正，在ADI五等份中，公共保险与较差的结局相关，而私人保险与较好的结局相关（大多数组合的P<0.05）。
邻里层面的ADI指标与哮喘住院结局相关。然而，保险覆盖范围会改变这种关系，在使用ADI识别和解决医疗保健差异时需要考虑这一点。
