Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
JAMA Netw Open. 2019 Sep 4;2(9):e1910878. doi: 10.1001/jamanetworkopen.2019.10878.
Descriptive population-level health data are critical components of the evidence base for population health policy. Human populations often display marked heterogeneity in their health status among subgroups of the population. The recent widespread adoption of electronic health records provides opportunities to use routine real-world health care data to examine population health.
To report population sociodemographic characteristics, health conditions, health care utilization, and health care costs for different population segments of a multiethnic Asian population divided according to a modified British Columbia Population Segmentation Framework.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used 2016 data from the Singapore Eastern Regional Health System, the largest Regional Health System in Singapore. Data were obtained from deidentified national-level electronic health records at the Ministry of Health Singapore. Participants included all residents in the Singapore Eastern Regional Health System catchment area in 2016. The descriptive analysis was conducted in August 2018.
Socioeconomic profiles, disease prevalence, health care utilization, and cost patterns of population segments.
The total size of the study population in 2016 was 1 181 024 residents (576 663 [48.83%] male; median [interquartile range] age, 40 [22-57] years). The population was divided into 8 segments: healthy with no outpatient utilization (493 483 residents), healthy with outpatient utilization (259 909 residents), healthy with inpatient admissions (49 588 residents), low complex (215 134 residents), medium complex (79 350 residents), high complex (44 445 residents), cancer (34 217 residents), and end of life (4898 residents). Overall, the 3 most prevalent conditions were chronic kidney disease (31.89%), hypertension (18.52%), and lipid disorders (18.33%). Distributions of chronic conditions differed across the segments. Different segments had varying health care utilization patterns: the high-complex segment had the highest number of primary care clinic visits (mean [SD], 4.25 [5.46] visits), the cancer segment had the highest number of specialist outpatient clinic visits (mean [SD], 5.55 [8.49] visits), and the end-of-life segment had the highest numbers of accident and emergency department visits (mean [SD], 1.80 [1.88] visits) and inpatient admissions (mean [SD], 1.99 [1.89] admissions) during 2016. For health care costs, specialist outpatient clinic and inpatient care together made up more than 85% of the total cost of nearly 2 billion Singapore dollars. The end-of-life segment contributed approximately 50% of the health care cost per capita of 60 000 Singapore dollars.
Different population segments displayed heterogeneity in sociodemographic characteristics, health conditions, health care utilization, and health care cost patterns. This critical health information can be used as baseline data to inform regional and national health priorities for health services research and policy.
描述性人群健康数据是人群健康政策证据基础的关键组成部分。人群的健康状况在人群的亚组中表现出明显的异质性。电子健康记录的广泛采用最近为使用常规的真实世界医疗保健数据来研究人群健康提供了机会。
根据不列颠哥伦比亚省人口细分框架的修改版，报告一个多民族亚洲人群的不同人群亚组的人口社会人口统计学特征、健康状况、医疗保健利用情况和医疗保健费用。
设计、设置和参与者：这项基于人群的横断面研究使用了 2016 年新加坡东部区域保健系统的数据，这是新加坡最大的区域保健系统。数据来自新加坡卫生部国家一级的匿名电子健康记录。参与者包括 2016 年新加坡东部区域保健系统覆盖范围内的所有居民。描述性分析于 2018 年 8 月进行。
人群亚组的社会经济状况、疾病流行率、医疗保健利用情况和成本模式。
2016 年研究人群的总规模为 1181024 名居民（男性 576663 人[48.83%]；中位数[四分位间距]年龄为 40 [22-57]岁）。人群被分为 8 个亚组：无门诊就诊的健康人群（493483 人）、有门诊就诊的健康人群（259909 人）、有住院治疗的健康人群（49588 人）、低复杂度人群（215134 人）、中复杂度人群（79350 人）、高复杂度人群（44445 人）、癌症人群（34217 人）和生命终末期人群（4898 人）。总体而言，最常见的三种疾病是慢性肾脏病（31.89%）、高血压（18.52%）和血脂紊乱（18.33%）。不同的亚组存在不同的慢性疾病分布。不同的亚组有不同的医疗保健利用模式：高复杂度亚组的初级保健诊所就诊次数最多（平均[标准差]，4.25 [5.46]次就诊），癌症亚组的专科门诊就诊次数最多（平均[标准差]，5.55 [8.49]次就诊），生命终末期亚组的急症室就诊次数（平均[标准差]，1.80 [1.88]次就诊）和住院人数（平均[标准差]，1.99 [1.89]次就诊）最高。在医疗保健费用方面，专科门诊和住院治疗费用加起来占近 20 亿新元的总费用的 85%以上。生命终末期亚组的人均医疗保健费用占 60000 新元的近 50%。
不同的人群亚组在社会人口统计学特征、健康状况、医疗保健利用情况和医疗保健费用模式方面表现出异质性。这些关键健康信息可用作基准数据，为区域和国家卫生服务研究和政策提供信息。
