周末效应真的普遍存在吗？利用来自澳大利亚新南威尔士州的关联人口数据，按星期几和一天中的时间对30天死亡率进行的回顾性临床队列分析。

Is the weekend effect really ubiquitous? A retrospective clinical cohort analysis of 30-day mortality by day of week and time of day using linked population data from New South Wales, Australia.

作者信息

Baldwin Heather J, Marashi-Pour Sadaf, Chen Huei-Yang, Kaldor Jill, Sutherland Kim, Levesque Jean-Frederic

机构信息

Bureau of Health Information, Chatswood, New South Wales, Australia.

Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2018 Apr 12;8(4):e016943. doi: 10.1136/bmjopen-2017-016943.

DOI:10.1136/bmjopen-2017-016943

PMID:29654003

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5898331/

Abstract

OBJECTIVE

To examine the associations between day of week and time of admission and 30-day mortality for six clinical conditions: ischaemic and haemorrhagic stroke, acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease and congestive heart failure.

DESIGN

Retrospective population-based cohort analyses. Hospitalisation records were linked to emergency department and deaths data. Random-effect logistic regression models were used, adjusting for casemix and taking into account clustering within hospitals.

SETTING

All hospitals in New South Wales, Australia, from July 2009 to June 2012.

PARTICIPANTS

Patients admitted to hospital with a primary diagnosis for one of the six clinical conditions examined.

OUTCOME MEASURES

Adjusted ORs for all-cause mortality within 30 days of admission, by day of week and time of day.

RESULTS

A total of 148 722 patients were included in the study, with 17 721 deaths within 30 days of admission. Day of week of admission was not associated with significantly higher likelihood of death for five of the six conditions after adjusting for casemix. There was significant variation in mortality for chronic obstructive pulmonary disease by day of week; however, this was not consistent with a strict weekend effect (Thursday: OR 1.29, 95% CI 1.12 to 1.48; Friday: OR 1.25, 95% CI 1.08 to 1.44; Saturday: OR 1.18, 95% CI 1.02 to 1.37; Sunday OR 1.05, 95% CI 0.90 to 1.22; compared with Monday). There was evidence for a night effect for patients admitted for stroke (ischaemic: OR 1.30, 95% CI 1.17 to 1.45; haemorrhagic: OR 1.58, 95% CI 1.40 to 1.78).

CONCLUSIONS

Mortality outcomes for these conditions, adjusted for casemix, do not vary in accordance with the weekend effect hypothesis. Our findings support a growing body of evidence that questions the ubiquity of the weekend effect.

摘要

目的

研究一周中的日期和入院时间与六种临床病症（缺血性和出血性中风、急性心肌梗死、肺炎、慢性阻塞性肺疾病和充血性心力衰竭）30天死亡率之间的关联。

设计

基于人群的回顾性队列分析。住院记录与急诊科和死亡数据相关联。使用随机效应逻辑回归模型，对病例组合进行调整并考虑医院内部的聚类情况。

设置

2009年7月至2012年6月期间澳大利亚新南威尔士州的所有医院。

参与者

因六种所研究临床病症之一而入院的患者。

观察指标

按一周中的日期和一天中的时间划分，入院30天内全因死亡率的调整后比值比。

结果

共有148722名患者纳入研究，其中17721人在入院30天内死亡。在调整病例组合后，六种病症中有五种病症的入院日期与死亡可能性显著升高无关。慢性阻塞性肺疾病的死亡率按一周中的日期存在显著差异；然而，这与严格的周末效应不一致（周四：比值比1.29，95%置信区间1.12至1.48；周五：比值比1.25，95%置信区间1.08至1.44；周六：比值比1.18，95%置信区间1.02至1.37；周日：比值比1.05，95%置信区间0.90至1.22；与周一相比）。有证据表明中风患者存在夜间效应（缺血性：比值比1.30，95%置信区间1.17至1.45；出血性：比值比1.58，95%置信区间1.40至1.78）。