Blecha S, Schlitt H J, Graf B M, Leitzmann M, Bein T
Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
Anaesthesist. 2018 May;67(5):336-342. doi: 10.1007/s00101-018-0430-9. Epub 2018 Mar 21.
In critical illnesses low socioeconomic status (SES) is associated with higher morbidity and mortality. In addition to the SES, further factors at an individual level (e.g., sex, health insurance status and place of residence) may influence the severity of illness and medical treatment. We investigated these additional parameters in a secondary analysis of the ECSSTASI data.
Within the framework of the ECSSTASI study, 996 patients were recruited from a surgical intensive care unit. We examined the influence of sex, insurance status and place of residence on health-related behavior, disease severity, duration of intensive care and ventilation (28 ventilator-free days score, 28-VFDS) and social support by the next of kin. Multivariate-adjusted logistic regression analyses were carried out and odds ratios (OR) are presented with corresponding 95% confidence intervals.
Among patients admitted to the intensive care unit, the disease severity (SOFA score >5) was significantly lower in women than in men (OR 0.62 [0.45-0.87]). Increasing size of the patient's town of residence was associated with a significantly shorter duration of treatment on the intensive care unit (OR 0.54 [0.32-0.91]). An increasing number of persons in the household was associated with a significantly increased risk of being ventilated longer compared to 1‑person households (p = 0.028). Patients with private insurance (OR 1.87 [1.28-2.70]), patients from households with ≥4 persons (OR 1.92 [1.1-3.33]) and patients without German citizenship (OR 2.56 [1.39-4.55]) were visited significantly more often by next of kin.
In addition to the SES, sociodemographic characteristics of the individual patient are associated with the course of treatment in intensive care medicine. The extent of social support by the next of kin depends on intercultural and individual patient characteristics. An increasing size of the town of residence and private health insurance status positively influence intensive care outcomes. In order to evaluate these data, further epidemiological studies in intensive care medicine are necessary.
在危重病中，社会经济地位低下与更高的发病率和死亡率相关。除社会经济地位外，个体层面的其他因素（如性别、健康保险状况和居住地）可能会影响疾病的严重程度和医疗治疗。我们在对ECSSTASI数据的二次分析中研究了这些额外参数。
在ECSSTASI研究框架内，从外科重症监护病房招募了996名患者。我们研究了性别、保险状况和居住地对健康相关行为、疾病严重程度、重症监护和通气持续时间（28天无呼吸机天数评分，28-VFDS）以及亲属社会支持的影响。进行了多变量调整的逻辑回归分析，并给出了优势比（OR）及相应的95%置信区间。
在入住重症监护病房的患者中，女性的疾病严重程度（序贯器官衰竭评估评分>5）显著低于男性（OR 0.62 [0.45 - 0.87]）。患者居住城镇规模的增大与重症监护病房治疗时间显著缩短相关（OR 0.54 [0.32 - 0.91]）。与单人家庭相比，家庭人口数增加与通气时间延长的风险显著增加相关（p = 0.028）。有私人保险的患者（OR 1.87 [1.28 - 2.70]）、来自家庭人口≥4人的患者（OR 1.92 [1.1 - 3.33]）和无德国公民身份的患者（OR 2.56 [1.39 - 4.55]）亲属探访的频率显著更高。
除社会经济地位外，个体患者的社会人口学特征与重症医学的治疗过程相关。亲属的社会支持程度取决于跨文化和个体患者特征。居住城镇规模的增大和私人健康保险状况对重症监护结果有积极影响。为了评估这些数据，有必要在重症医学领域开展进一步的流行病学研究。
