Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA.
BMJ Open. 2019 Oct 28;9(10):e031556. doi: 10.1136/bmjopen-2019-031556.
To study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income.
Serial cross-sectional study testing the association between hospitalisation rates and zip code-level median income, with subgroup analyses by zip code income and race.
PARTICIPANTS/SETTING: Our study included all hospitalised adults over 18 years old living in California in 2001 and 2011 who were not pregnant or incarcerated. This included all acute-care hospitalisations in California including 1632 zip codes in 2001 and 1672 zip codes in 2011.
We compared age-standardised hospitalisations per 100 000 persons, overall and for several disease categories.
There were 1.58 and 1.78 million hospitalisations in California in 2001 and 2011, respectively. Spatial analysis showed the highest hospitalisation rates in urban inner cities and rural areas, with more than 5000 hospitalisations per 100 000 persons. Hospitalisations per 100 000 persons were consistently highest in the lowest zip code income quintile and particularly among black patients.
Hospitalisation rates rose from 2001 to 2011 among Californians living in low-income and middle-income zip codes. Integrating spatially defined state hospital discharge and federal zip code income data provided a granular description of disease burden. This method may help identify high-risk areas and evaluate public health interventions targeting health disparities.
通过比较加利福尼亚州 2001 年和 2011 年按邮区中位数家庭收入划分的住院率，研究基于地点的社会经济因素与疾病分布的关联。
通过按邮区收入和种族进行亚组分析，测试住院率与邮区中位数收入之间关联的连续横断面研究。
参与者/设置：我们的研究包括 2001 年和 2011 年居住在加利福尼亚州、年龄在 18 岁以上且未怀孕或被监禁的所有成年住院患者。这包括加利福尼亚州所有的急性护理住院患者，包括 2001 年的 1632 个邮区和 2011 年的 1672 个邮区。
我们比较了每 100000 人年龄标准化的住院人数，包括总体和几种疾病类别。
2001 年和 2011 年加利福尼亚州分别有 158 万和 178 万例住院。空间分析显示，城市中心内城区和农村地区的住院率最高，每 100000 人中有超过 5000 例住院。每 100000 人中有超过 5000 例住院的邮区收入最低五分位数和黑人患者的住院率始终最高。
居住在低收入和中等收入邮区的加利福尼亚人，其住院率从 2001 年到 2011 年上升。整合空间定义的州医院出院数据和联邦邮区收入数据，提供了疾病负担的详细描述。这种方法可能有助于确定高风险地区，并评估针对健康差距的公共卫生干预措施。
