一种创新的个体层面社会经济衡量指标可预测老年重症患者的预后：一项基于人群的研究。
An Innovative Individual-Level Socioeconomic Measure Predicts Critical Care Outcomes in Older Adults: A Population-Based Study.
机构信息
Division of Pulmonary and Critical Care Medicine, 4352Mayo Clinic, Rochester, MN, USA.
Precision Population Science lab 4352Mayo Clinic, Rochester, MN, USA.
出版信息
J Intensive Care Med. 2021 Jul;36(7):828-837. doi: 10.1177/0885066620931020. Epub 2020 Jun 25.
BACKGROUND
Little is known about the impact of socioeconomic status (SES) as a key element of social determinants of health on intensive care unit (ICU) outcomes for adults.
OBJECTIVE
We assessed whether a validated individual SES index termed HOUSES (HOUsing-based SocioEconomic status index) derived from housing features was associated with short-term outcomes of critical illness including ICU mortality, ICU-free days, hospital-free days, and ICU readmission.
METHODS
We performed a population-based cohort study of adult patients living in Olmsted County, Minnesota, admitted to 7 intensive care units at Mayo Clinic from 2011 to 2014. We compared outcomes between the lowest SES group (HOUSES quartile 1 [Q1]) and the higher SES group (HOUSES Q2-4). We stratified the cohort based on age (<50 years old and ≥50 years old).
RESULTS
Among 4134 eligible patients, 3378 (82%) patients had SES successfully measured by the HOUSES index. Baseline characteristics, severity of illness, and reason for ICU admission were similar among the different SES groups as measured by HOUSES except for larger number of intoxications and overdoses in younger patients from the lowest SES. In all adult patients, there were no overall differences in mortality, ICU-free days, hospital-free days, or ICU readmissions in patients with higher SES compared to lower SES. Among older patients (>50 years), those with higher SES (HOUSES Q2-4) compared to those with lower SES (HOUSES Q1) had lower mortality rates (hazard ratio = 0.72; 95% CI: 0.56-0.93; adjusted = .01), increased ICU-free days (mean 1.08 days; 95% CI: 0.34-1.84; adjusted = .004), and increased hospital-free days (mean 1.20 days; 95% CI: 0.45-1.96; adjusted = .002). There were no differences in ICU readmission rates (OR = 0.74; 95% CI: 0.55-1.00; = .051).
CONCLUSION
Individual-level SES may be an important determinant or predictor of critical care outcomes in older adults. Housing-based socioeconomic status may be a useful tool for enhancing critical care research and practice.
背景
社会决定健康因素中的社会经济地位（SES）作为关键因素，其对成人重症监护病房（ICU）结局的影响知之甚少。
目的
我们评估了一种源自住房特征的经过验证的个体 SES 指数，即 HOUSES（基于住房的社会经济地位指数），其是否与危重疾病的短期结局相关，包括 ICU 死亡率、ICU 无天数、住院无天数和 ICU 再入院。
方法
我们对明尼苏达州奥姆斯特德县的成年患者进行了一项基于人群的队列研究，这些患者于 2011 年至 2014 年期间在梅奥诊所的 7 个 ICU 中住院。我们比较了最低 SES 组（HOUSES 四分位数 1 [Q1]）和较高 SES 组（HOUSES Q2-4）之间的结局。我们根据年龄（<50 岁和≥50 岁）对队列进行分层。
结果
在 4134 名合格患者中，有 3378 名（82%）患者的 SES 通过 HOUSES 指数成功测量。除了年轻患者中中毒和过量用药的数量较多外，不同 SES 组之间的基线特征、疾病严重程度和 ICU 入院原因相似。在所有成年患者中，与 SES 较低的患者相比，SES 较高的患者（HOUSES Q2-4）在死亡率、ICU 无天数、住院无天数或 ICU 再入院方面无总体差异。在年龄较大的患者（>50 岁）中，与 SES 较低的患者（HOUSES Q1）相比，SES 较高的患者（HOUSES Q2-4）死亡率较低（风险比=0.72；95%CI：0.56-0.93；调整 =.01），ICU 无天数增加（平均 1.08 天；95%CI：0.34-1.84；调整 =.004），住院无天数增加（平均 1.20 天；95%CI：0.45-1.96；调整 =.002）。ICU 再入院率无差异（OR=0.74；95%CI：0.55-1.00； =.051）。
结论
个体 SES 可能是老年重症监护结局的重要决定因素或预测因素。基于住房的社会经济地位可能是加强重症监护研究和实践的有用工具。
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