Jaworsky Denise, Loutfy Mona, Lu Michelle, Ye Monica, Bratu Andreea, Sereda Paul, Bayoumi Ahmed, Richardson Lisa, Kuper Ayelet, Hogg Robert S
Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC.
CMAJ Open. 2020 Oct 19;8(4):E643-E650. doi: 10.9778/cmajo.20200066. Print 2020 Oct-Dec.
Improving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used.
We performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression: rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems.
Virologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas.
Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
改善农村地区的健康状况通常被视为加拿大研究和政策的优先领域。我们研究了根据农村地区定义的不同，关于艾滋病毒治疗结果（病毒学抑制）的研究结果如何存在差异。
我们使用“比较结果与服务利用趋势”研究中的基于人群的队列进行回顾性队列分析，该队列研究对象为2012年4月1日至2013年3月31日期间居住在不列颠哥伦比亚省的成年艾滋病毒感染者（年龄≥19岁）。我们使用以下地理变量进行单因素逻辑回归分析，以预测艾滋病毒的病毒学抑制情况：由邮政编码前三位区域定义的农村地区、由统计区域分类定义的农村地区以及由卫生当局定义的农村地区。我们使用地理信息系统绘制抑制情况图。
8598名参与者中有5605名（65.2%）实现了病毒学抑制。在单因素分析中，由统计区域分类定义的农村地区（优势比[OR]为0.73，95%置信区间[CI]为0.65 - 0.82）与较低的抑制几率相关，而由邮政编码前三位区域定义的农村地区则不然。当我们按卫生当局检查抑制情况时，北部卫生区的抑制几率最低（与温哥华沿海卫生区相比，OR为0.46，95% CI为0.36 - 0.58）。地理信息系统绘制的地图显示北部地区的抑制情况较差。
健康结果的研究结果可能因地理变量的定义而异。当纳入地理变量时，研究人员应仔细考虑变量定义，以及对于他们的分析而言，诸如南北划分等其他分类系统是否比农村地区定义更合适。
