Service de Pédiatrie Générale, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France.
Inserm, ECEVE, U1123, 10 boulevard de Verdun, 75010 Paris, France.
Int Health. 2022 Jul 1;14(4):405-412. doi: 10.1093/inthealth/ihz102.
To identify deprivation indicators usable in everyday practice and included in medico-administrative databases, particularly with infectious diseases, which represent the greatest proportion of hospitalizations. Our objective was to compare ecological indicators to individual questionnaires and apply both types to the study of the impact of deprivation on hospital efficiency.
We conducted an epidemiological observational prospective multicentre study in two French public hospitals between 20 October 2016 and 20 March 2017. Children hospitalized for one of the four most common infectious diseases were included and their parents were asked to answer the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. The ecological indicator French DEPrivation index (FDep) was derived from patients' address, both at the zip code and at a smaller geographical area (IRIS [ilôts de regroupement pour l'information statistique]) level. Correlation and concordance between the three indicators were assessed. The endpoint used to assess the impact on hospital efficiency was the ratio between patients' length of stay (LOS) and the national LOS of their disease-related group.
Data were available for 540 patients with a mean age of 9 mo. A total of 56.1% of patients were considered deprived with EPICES, 50.4% with zip code FDep and 45.7% with IRIS FDep. Concordance between EPICES and either type of FDep was <0.1. There was no increase in LOS compared with national LOS with any of the indicators.
Individual and ecological indicators do not measure the same aspects of deprivation. The decision to use one or the other must be carefully weighed when studying the impact of deprivation on the healthcare system.
为了确定可在日常实践中使用的剥夺指标，并将其纳入医疗管理数据库，特别是与传染病相关的指标，因为传染病在住院患者中占比最大。我们的目的是比较生态指标与个体问卷，并将这两种方法应用于研究贫困对医院效率的影响。
我们在法国两家公立医院进行了一项前瞻性的、多中心的、流行病学观察研究。研究对象为因四种最常见传染病之一而住院的儿童，其父母需要回答健康中心脆弱性和不平等评估问卷（EPICES）。从患者地址（邮政编码和更小的地理区域[IRIS（统计信息聚集小岛）]级别）中提取了生态指标法国 DEPrivation 指数（FDep）。评估了这三个指标之间的相关性和一致性。用来评估医院效率的终点是患者的住院时间（LOS）与疾病相关组的全国 LOS 之间的比值。
共纳入了 540 名年龄中位数为 9 个月的患者。56.1%的患者被 EPICES 评估为贫困，50.4%的患者根据邮政编码 FDep 评估为贫困，45.7%的患者根据 IRIS FDep 评估为贫困。EPICES 与 FDep 之间的一致性 <0.1。任何指标都没有增加 LOS 与全国 LOS 的比值。
个体和生态指标并不测量贫困的相同方面。在研究贫困对医疗保健系统的影响时，必须仔细权衡使用一种或另一种指标的决策。
