Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
J Infect. 2020 Nov;81(5):736-742. doi: 10.1016/j.jinf.2020.08.048. Epub 2020 Sep 1.
Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England.
A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012-17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups (0-14; 15-64; 65+ years). Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood.
From 2012-17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children [IRR=1.06, 95%CI 1.06-1.07], adults [IRR=1.02, 95%CI 1.02-1.03] and older adults [IRR=1.04, 95%CI 1.036-1.043], respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates.
Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities.
先前的研究表明，传染性肠道疾病（IID）相关的住院治疗在贫困社区更为普遍。这些研究主要集中在儿科人群，且多为横断面研究。本研究通过纵向方法，探讨了急诊 IID 入院率的近期趋势，并调查了失业（作为衡量社区贫困的时变指标）和其他社会人口特征对英格兰成人和儿童 IID 入院的影响。
本研究采用英格兰 2012-17 年期间收集的医院急诊 IID 住院数据，在邻里（低层次超区）层面上对三个年龄组（0-14 岁、15-64 岁、65 岁以上）进行了纵向生态分析。采用混合效应泊松回归模型，控制初级和二级医疗保健的可及性、基础发病率和每个邻里的种族构成，评估邻里失业与急诊 IID 入院率之间的趋势关系。
2012-17 年期间，总体而言，儿童和老年人群的急诊 IID 入院率呈下降趋势，而某些人群亚组的入院率则有所上升。失业每增加 1 个百分点，儿童[相对危险度（IRR）=1.06，95%置信区间（CI）1.06-1.07]、成人（IRR=1.02，95%CI 1.02-1.03）和老年人群（IRR=1.04，95%CI 1.036-1.043）的 IID 入院率每年分别增加 6.3%、2.4%和 4%。邻里初级医疗保健可及性较差、巴基斯坦裔人口比例较高、长期健康问题普遍等因素也与 IID 入院率的上升有关。
以失业衡量的邻里贫困程度的上升趋势与英格兰儿童和成人急诊 IID 入院率的上升有关，尽管控制了医疗保健可及性、基础发病率和种族等因素。需要进一步研究以深入了解解释这些不平等现象的机制，从而制定有效的政策来降低贫困社区较高的急诊 IID 入院率。
