社会梯度与急诊医学中心肌梗死和中风诊断。
Social Gradients in Myocardial Infarction and Stroke Diagnoses in Emergency Medicine.
机构信息
Department of Medicine III, St. Josef and St. Elisabeth Hospital, Bochum; Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin; Department of Medical Informatics, Biometrics and Epidemiology, University of Bochum; Department of Medicine II - Cardiology, St. Josef Hospital, Bochum University Hospitals.
出版信息
Dtsch Arztebl Int. 2018 Jan 26;115(4):41-48. doi: 10.3238/arztebl.2018.0041.
BACKGROUND
Persons of lower socio-economic status are at higher risk of disease, especially with respect to severe and chronic illnesses. To date, there have not been any studies with large case numbers regarding acute medical emergencies in this population.
METHODS
In a retrospective study, data were obtained on all cases treated by emergency physicians in Bochum, Germany, in 2014/2015, including the diagnoses that were made by the emergency physicians. There were a total of 16 767 cases. The local unemployment rate was taken as an indicator of the socioeconomic situation of a neighborhood; it was defined as the percentage of registered unemployed persons among persons aged 15 to 64 with their domicile in the neighborhood. 12 168 cases were grouped by emergency medical diagnosis and analyzed with respect to the three most heavily represented diagnostic categories (cardiovascular, neurological, and pulmonary emergencies), which accounted for nearly two-thirds of all diagnoses.
RESULTS
The overall rates of deployment involving emergency physicians were found to be positively correlated with the unemployment rate. After adjustment for age, sex, and possible confounders, this correlation was statistically significant (p<0.01). The indirectly standardized rate ratio (IRR) for the overall case-activity rate ranged from 0.841 (95% confidence interval: [0.808; 0.875]) with less than 5% unemployment to 1.212 [1.168; 1.256] with 9.5% unemployment or higher. The same finding was obtained with respect to diagnosis-specific case activity in each of the three main diagnostic categories (cardiovascular, neurological, and pulmonary emergencies), as well as for the respective commonest individual diagnoses (acute coronary syndrome/circulatory arrest [1498 cases], transient ischemic attack/ischemic stroke/intracerebral hemorrhage [1274 cases], and asthma/chronic obstructive pulmonary disease [663 cases]).
CONCLUSION
This study shows that the case-activity rate of the emergency medical services is significantly higher in socially disadvantaged neighborhoods, both with respect to total numbers and with respect to individual diseases. It demonstrates a problem affecting society as a whole, which should be taken into account in the organization of medical rescue services.
背景
社会经济地位较低的人群患疾病的风险更高，尤其是严重和慢性疾病。迄今为止，针对该人群的急性医疗急救情况，还没有任何大样本数量的研究。
方法
在一项回顾性研究中，获取了德国波鸿市 2014/2015 年所有由急诊医师治疗的病例数据，包括急诊医师的诊断。共有 16767 例。当地失业率被用作邻里社会经济状况的指标；它被定义为邻里内 15 至 64 岁登记失业人数占该年龄段人口的百分比。根据急诊医疗诊断，将 12168 例病例进行分组，并对三个占比最大的诊断类别（心血管、神经和肺部紧急情况）进行分析，这三个类别占所有诊断的近三分之二。
结果
总体上，急诊医师的出动率与失业率呈正相关。调整年龄、性别和可能的混杂因素后，这种相关性具有统计学意义（p<0.01）。整体病例活动率的间接标准化比率（IRR）范围为 0.841（95%置信区间：[0.808；0.875]），失业率低于 5%，到 1.212 [1.168；1.256]，失业率为 9.5%或更高。在三个主要诊断类别（心血管、神经和肺部紧急情况）中的每个诊断类别中，以及在各自最常见的个体诊断（急性冠状动脉综合征/循环骤停[1498 例]、短暂性脑缺血发作/缺血性中风/脑出血[1274 例]和哮喘/慢性阻塞性肺疾病[663 例]）中，也得到了相同的发现。
结论
本研究表明，在社会弱势群体中，急诊医疗服务的病例活动率无论是在总数还是在个别疾病方面都显著更高。它表明了一个影响整个社会的问题，在医疗救援服务的组织中应予以考虑。
Zotero 插件