Department of Obstetrics and Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
School of Public Health, University of Alberta, Edmonton, Canada.
Paediatr Perinat Epidemiol. 2020 Mar;34(2):150-160. doi: 10.1111/ppe.12639. Epub 2020 Feb 3.
Socio-economically deprived children face a disproportionate burden of respiratory diseases. The association between area-level material and social deprivation and emergency department (ED) visits and hospitalisations for paediatric respiratory diseases has not been explored.
We evaluated health inequalities in emergency department (ED) visits and hospitalisations for paediatric respiratory diseases according to material and social deprivation indexes.
This population-based retrospective cohort study deterministically linked birth, ED visits and hospitalisation data, and census-based, area-level deprivation indexes for all singleton children born in the province of Alberta, Canada, between 2005 and 2010 who had at least one recorded ED visit or hospitalisation for respiratory diseases in their first five years of life. We classified ED visits and hospitalisations for seven respiratory diseases by deprivation indexes. Concentration indexes (CInd) and area-level concentration curves measured health gradients across deprivation groups. Rate ratios (RR) evaluated associations between deprivation indexes and respiratory episodes of care.
The study cohort included 198 572 newborns. The highest CInd were found in ED visits for other acute lower respiratory tract infections (oLRTI; CInd -0.22, 95% confidence interval [CI] -0.32, -0.12) and bronchiolitis (CInd -0.21, 95% CI -0.29, -0.12), and for pneumonia hospitalisations (CInd -0.23, 95% CI -0.33, -0.13). Croup ED visits had a low inequality degree. Compared to social deprivation, the material deprivation index presented a more consistent health gradient of increased episodes of care with increasing deprivation. oLRTI ED visits (RR 2.60, 95% CI 2.34, 2.92) and pneumonia hospitalisations (RR 2.57, 95% CI 2.31, 2.86) presented the largest inequalities between the least and most materially deprived groups.
We found a concentration of ED visits and hospitalisations for paediatric respiratory diseases in the most deprived groups. However, health inequalities are present across the material and social deprivation spectrum. Compared to the social deprivation index, the material index presented clearer paediatric respiratory health gradients.
社会经济贫困的儿童面临着不成比例的呼吸道疾病负担。尚未探讨地区物质和社会剥夺与儿科呼吸道疾病急诊就诊和住院之间的关系。
根据物质和社会剥夺指数，评估儿科呼吸道疾病急诊就诊和住院的健康不平等。
本基于人群的回顾性队列研究通过确定性链接了出生、急诊就诊和住院数据，以及加拿大艾伯塔省 2005 年至 2010 年间出生的所有单胎儿童的基于人口普查的、地区层面的剥夺指数，这些儿童在五岁前至少有一次记录的急诊就诊或因呼吸道疾病住院。我们根据剥夺指数对七种呼吸道疾病的急诊就诊和住院进行分类。集中指数（CInd）和地区水平集中曲线衡量了不同贫困组的健康梯度。比率比（RR）评估了剥夺指数与呼吸道护理发作之间的关联。
研究队列包括 198572 名新生儿。在其他急性下呼吸道感染（oLRTI；CInd -0.22，95%置信区间 [CI] -0.32，-0.12）和细支气管炎（CInd -0.21，95% CI -0.29，-0.12）的急诊就诊和肺炎住院（CInd -0.23，95% CI -0.33，-0.13）中，CInd 最高。喉炎急诊就诊的不平等程度较低。与社会剥夺相比，物质剥夺指数在不同的物质剥夺水平下呈现出更一致的健康梯度，即随着物质剥夺程度的增加，呼吸道疾病的就诊和住院次数也随之增加。oLRTI 急诊就诊（RR 2.60，95% CI 2.34，2.92）和肺炎住院（RR 2.57，95% CI 2.31，2.86）在最贫穷和最物质上受剥夺的群体之间存在最大的不平等。
我们发现儿科呼吸道疾病的急诊就诊和住院集中在最贫困的群体中。然而，健康不平等存在于物质和社会剥夺的整个范围内。与社会剥夺指数相比，物质指数呈现出更清晰的儿科呼吸道健康梯度。
