美国各地急诊部评估的疝病复杂性的社会经济差异。
Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States.
机构信息
Research Centers in Minority Institutions Program, Howard University College of Medicine, 520 W Street NW, Rm 436, Washington, DC, 20059, USA; Clive O. Callender, MD Howard-Harvard Health Sciences Outcomes Research Center, Howard University, 2041 Georgia Avenue, NW, Suite 4B-35, Washington, DC, 20060, USA.
Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA.
出版信息
Am J Surg. 2019 Sep;218(3):551-559. doi: 10.1016/j.amjsurg.2018.11.042. Epub 2018 Dec 14.
BACKGROUND
Hernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED).
METHODS
Retrospective analysis of 2006-2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation.
RESULTS
Among 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50-1.61) and uninsured (OR 1.73 95%CI 1.67-1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80-0.84 and OR 0.77 95%CI 0.75-0.79), respectively.
CONCLUSION
Uninsured, publicly-insured, and low-MHI patients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.
背景
疝是最常见的外科疾病之一，对医疗支出负担沉重。我们研究了急诊患者社会经济地位和表现复杂性的影响。
方法
对 2006-2014 年全国急诊样本数据进行回顾性分析，确定了腹股沟、股疝和脐疝的成人出院诊断。将病例分为复杂和不复杂两类。采用未调整和调整分析来确定影响 ED 就诊的因素。
结果
在纳入的 264484 例患者中，73%表现为不复杂的疝，在城市医院（86%）接受评估。医疗补助（OR 1.56 95%CI1.50-1.61）和无保险（OR 1.73 95%CI 1.67-1.78）的患者更可能出现不复杂的表现，但在第三和第四 MHI 四分位数的患者中，这种情况较少（OR 0.82 95%CI 0.80-0.84 和 OR 0.77 95%CI 0.75-0.79）。
结论
未参保、公共参保和低 MHI 患者更有可能因不复杂的疝而到 ED 就诊。这一发现可能反映了非紧急手术疾病缺乏获得初级手术护理的机会。
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