Lee David C, Feldman Justin M, Osorio Marcela, Koziatek Christian A, Nguyen Michael V, Nagappan Ashwini, Shim Christopher J, Vinson Andrew J, Thorpe Lorna E, McGraw Nancy A
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
Department of Population Health, New York University School of Medicine, New York City, New York, USA.
BMJ Open. 2019 Nov 18;9(11):e033373. doi: 10.1136/bmjopen-2019-033373.
Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level.
We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County.
Sullivan County, a rural county ranked second-to-last for health outcomes in New York State.
Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015.
We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas.
Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses.
For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.
美国农村地区存在一些最为紧迫的健康问题。然而，这些地区追踪和预防疾病所需的监测工作却有所欠缺。我们的目标是对一个农村县进行全面的健康调查，以评估利用急诊索赔数据在县以下层面估算农村疾病患病率的有效性。
我们开展了一项横断面研究，对比使用急诊科（ED）索赔数据得出的慢性病患病率估算值与旨在涵盖纽约州农村地区沙利文县大部分居民的邮寄健康调查问卷结果。
沙利文县是纽约州健康状况排名倒数第二的农村县。
2017 - 2018年对健康调查做出回应或在2011 - 2015年至少有过一次急诊就诊经历的25岁及以上沙利文县成年居民。
我们比较了九个县以下地区经年龄和性别调整后的高血压、高脂血症、糖尿病、癌症、哮喘以及慢性阻塞性肺疾病/肺气肿的患病率。
我们在全县范围内进行的邮寄调查共获得6675份完整回复，回复率为30.4%。该样本占沙利文县估计的53020名成年人的12%以上。利用急诊索赔数据，我们确定了2011 - 2015年期间至少去过一次急诊科的34576名沙利文县成年人。在县以下层面，邮寄调查问卷和急诊索赔数据得出的患病率估算值在糖尿病（r = 0.90）和哮喘（r = 0.85）方面相关性特别好。其他疾病的相关性则不太好（范围：0.23 - 0.46）。利用急诊索赔数据，我们使用地理编码地址创建了疾病患病率在地理上更详细的地图。
对于某些特定疾病来说，急诊索赔数据可能有助于追踪农村地区的疾病患病率，并提供地理上更详细的估算值。对于缺乏健全健康监测的农村地区，急诊索赔数据可为如何在地理上有针对性地开展慢性病预防工作提供参考。
