1 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
2 School of Planning, University of Waterloo, Waterloo, Ontario, Canada.
Can J Psychiatry. 2018 Jun;63(6):404-409. doi: 10.1177/0706743717745870. Epub 2018 Feb 6.
This study examined relationships among hospital accessibility, socio-economic context, and geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders in Ontario, Canada.
A retrospective cross-sectional analysis was conducted using admissions data from 71 hospitals with inpatient psychiatry beds in Ontario, Canada between 2011 and 2014. Data included 7,637 unique admissions for 4,550 adults with a DSM-IV diagnosis of Delirium, Dementia, Amnestic and other Cognitive Disorders. Bayesian spatial Poisson regression was employed to examine the relationship between accessibility of general hospitals with psychiatric beds and psychiatric hospitals, area-level marginalization, and hospitalization rate with the risk of admission to inpatient psychiatry among adults with cognitive disorders across 516 Forward Sortation Areas (FSA) in Ontario.
Residential instability and the overall hospitalization rate were significantly associated with an increase in the relative risk of admissions to inpatient psychiatry. Accessibility to general hospitals and psychiatric hospitals were marginally insignificant at the 95% credible interval in the final model. Significant geographic clustering of admissions was identified where individuals residing in FSA's with the highest relative risk were 2.0 to 7.1 times more likely to be admitted to inpatient psychiatry compared to the average.
Geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders exists across the Province of Ontario, Canada. At the geographic level, the risk of admission was positively associated with residential instability and the overall hospitalization rate, but not distance to the closest general or psychiatric hospital.
本研究考察了加拿大安大略省成人认知障碍患者住院精神病学入院的医院可达性、社会经济背景和地理集聚之间的关系。
使用加拿大安大略省 71 家拥有住院精神病床位的医院在 2011 年至 2014 年期间的入院数据进行回顾性横断面分析。数据包括 7637 名患有 DSM-IV 诊断为谵妄、痴呆、遗忘症和其他认知障碍的 4550 名成人的独特入院。采用贝叶斯空间泊松回归检验普通医院和精神病医院可达性、地区边缘化水平、住院率与 516 个安大略省 FSA 中认知障碍成人住院精神病学入院风险之间的关系。
居住不稳定和总体住院率与精神病学入院的相对风险增加显著相关。在最终模型中，普通医院和精神病医院的可达性在 95%可信区间内具有边缘显著性。发现入院存在显著的地理集聚，与平均水平相比，居住在相对风险最高的 FSA 的个体更有可能被收治入院 2.0 至 7.1 倍。
加拿大安大略省存在成人认知障碍患者住院精神病学入院的地理集聚。在地理水平上，入院风险与居住不稳定和总体住院率呈正相关，而与最近的普通医院或精神病医院的距离无关。
