先天性心脏病成人患者在地理和社会人口学方面获得医疗服务差异的模型。
A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease.
作者信息
Salciccioli Katherine B, Oluyomi Abiodun, Lupo Philip J, Ermis Peter R, Lopez Keila N
机构信息
Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Environmental Health Service, Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas.
出版信息
Congenit Heart Dis. 2019 Sep;14(5):752-759. doi: 10.1111/chd.12819. Epub 2019 Jul 30.
BACKGROUND
Follow-up at a regional adult congenital heart disease (ACHD) center is recommended for all ACHD patients at least once per the 2018 ACC/AHA guidelines. Other specialties have demonstrated poorer follow-up and outcomes correlating with increased distance from health care providers, but driving time to regional ACHD centers has not been examined in the US population.
OBJECTIVE
To identify and characterize potential disparities in access to ACHD care in the US based on drive time to ACHD centers and compounding sociodemographic factors.
METHODS
Mid- to high-volume ACHD centers with ≥500 outpatient ACHD visits and ≥20 ACHD surgeries annually were included based on self-reported, public data. Geographic Information System mapping was used to delineate drive times to ACHD centers. Sociodemographic data from the 2012-2016 American Community Survey (US Census) and the Environmental Systems Research Institute were analyzed based on drive time to nearest ACHD center. Previously established CHD prevalence estimates were used to estimate the similarly located US ACHD population.
RESULTS
Nearly half of the continental US population (45.1%) lives >1 hour drive to an ACHD center. Overall, 39.7% live 1-4 hours away, 3.4% live 4-6 hours away, and 2.0% live >6 hours away. Hispanics were disproportionately likely to live a >6 hour drive to a center (p < .001). Compared to people with <1 hour drive, those living >6 hours away have higher proportions of uninsured adults (29% vs. 18%; p < .001), households below the federal poverty level (19% vs. 13%; p < .001), and adults with less than college education (18% vs. 12%; p < .001).
CONCLUSIONS
We estimate that ~45% of the continental US population lives >1 hour to an ACHD center, with 5.4% living >4 hours away. Compounding barriers exist for Hispanic, uninsured, lower socioeconomic status, and less-educated patients. These results may help drive future policy changes to improve access to ACHD care.
背景
根据2018年美国心脏病学会/美国心脏协会指南，建议所有成人先天性心脏病（ACHD）患者在地区性ACHD中心至少每年随访一次。其他专科已证明，随访情况较差以及结局与患者距医疗服务提供者的距离增加相关，但在美国人群中，前往地区性ACHD中心的驾车时间尚未得到研究。
目的
根据前往ACHD中心的驾车时间以及综合社会人口统计学因素，确定并描述美国在获得ACHD护理方面潜在的差异。
方法
根据自我报告的公开数据，纳入每年门诊ACHD就诊量≥500例且ACHD手术量≥20例的中高容量ACHD中心。使用地理信息系统绘图来确定前往ACHD中心的驾车时间。基于前往最近ACHD中心的驾车时间，分析了2012 - 2016年美国社区调查（美国人口普查）和环境系统研究所的社会人口统计学数据。使用先前确定的冠心病患病率估计值来估算美国大陆上位置相似的ACHD患者数量。
结果
美国大陆近一半人口（45.1%）居住在距ACHD中心驾车时间超过1小时的地方。总体而言，39.7%的人居住在1 - 4小时车程处，3.4%的人居住在4 - 6小时车程处，2.0%的人居住在超过6小时车程处。西班牙裔人群居住在距中心驾车时间超过6小时的可能性不成比例地高（p <.001）。与驾车时间少于1小时的人相比，居住在超过6小时车程处的人群中，未参保成年人比例更高（29%对18%；p <.001），家庭收入低于联邦贫困线的比例更高（19%对13%；p <.001），以及未接受过大学教育的成年人比例更高（18%对12%；p <.001）。
结论
我们估计，美国大陆约45%的人口居住在距ACHD中心驾车时间超过1小时的地方，5.4%的人居住在超过4小时车程处。西班牙裔患者、未参保患者、社会经济地位较低患者以及受教育程度较低患者存在多重障碍。这些结果可能有助于推动未来的政策变革，以改善ACHD护理的可及性。
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