Ohio State University College of Medicine, Columbus, Ohio.
Ohio State University College of Medicine, Columbus, Ohio; Ohio State University Center for Surgical Health Assessment, Research and Policy, Columbus, Ohio.
J Surg Res. 2021 May;261:376-384. doi: 10.1016/j.jss.2020.12.028. Epub 2021 Jan 22.
Emergency general surgery (EGS) patients are more socioeconomically vulnerable than elective counterparts. We hypothesized that a hospital's neighborhood disadvantage is associated with vulnerability of its EGS patients.
Area deprivation index (ADI), a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospital and EGS patient characteristics were compared across hospital ADI quartiles (least disadvantaged [ADI 1-25] "affluent," minimally disadvantaged [ADI 26-50] "min-da", moderately disadvantaged [ADI 51-75] "mod-da", and most disadvantaged [ADI 76-100] "impoverished") using chi tests and multivariable regression.
Higher disadvantage hospitals are more often nonteaching (affluent = 38.9%, min-da = 53.5%, mod-da = 72.1%, and impoverished = 67.6%), nonaffiliated with medical schools (50%, 72.4%, 81.8%, and 78.8%), and in rural areas (3.3%, 9.2%, 31.2%, and 27.9%). EGS patients at higher disadvantage hospitals are more likely to be older (43.9%, 48.6%, 49.1%, and 46.6%), have >3 comorbidities (17.0%, 19.0%, 18.4%, and 19.3%), live in low-income areas (21.4%, 23.6%, 32.2%, and 42.5%), and experience complications (23.2%, 23.7%, 24.0%, and 25.2%). Rates of uninsurance/underinsurance were highest at affluent and impoverished hospitals (18.0, 16.4%, 17.7%, and 19.2%). Higher disadvantage hospitals serve fewer minorities (32.6%, 21.3%, 20.7%, and 24.0%), except in rural areas (2.9%, 6.7%, 6.5%, and 15.5%). In multivariable analyses, the impoverished hospital ADI quartile did not predict odds of serving as a safety-net or predominantly minority-serving hospital.
Hospitals in impoverished areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons. These findings have implications for measures to improve equity in EGS outcomes.
急诊普通外科（EGS）患者比择期手术患者在社会经济方面更为脆弱。我们假设医院所在社区的劣势与 EGS 患者的脆弱性有关。
利用区域剥夺指数（ADI）对劣势进行了医院层面的衡量，并将其与 14 个州的 724 家医院和国家住院病人数据库中的患者数据相联系。使用卡方检验和多变量回归比较了不同医院 ADI 四分位数（最不劣势[ADI 1-25]“富裕”、最小劣势[ADI 26-50]“min-da”、中度劣势[ADI 51-75]“mod-da”和最劣势[ADI 76-100]“贫困”）之间的医院和 EGS 患者特征。
劣势较大的医院往往是非教学医院（富裕医院占 38.9%，min-da 医院占 53.5%，mod-da 医院占 72.1%，贫困医院占 67.6%），与医学院没有附属关系（50%、72.4%、81.8%和 78.8%），并且位于农村地区（3.3%、9.2%、31.2%和 27.9%）。在劣势较大的医院中，EGS 患者年龄更大（43.9%、48.6%、49.1%和 46.6%），合并症超过 3 种（17.0%、19.0%、18.4%和 19.3%），居住在低收入地区（21.4%、23.6%、32.2%和 42.5%），并且发生并发症的概率较高（23.2%、23.7%、24.0%和 25.2%）。在富裕医院和贫困医院中，无保险/保险不足的比例最高（18.0、16.4%、17.7%和 19.2%）。劣势较大的医院服务的少数民族较少（32.6%、21.3%、20.7%和 24.0%），但农村地区除外（2.9%、6.7%、6.5%和 15.5%）。多变量分析显示，贫困医院 ADI 四分位数并不能预测其作为安全网医院或主要服务少数民族医院的可能性。
贫困地区的医院不成比例地为服务不足的 EGS 患者群体提供服务，但为 EGS 护理或培养未来 EGS 外科医生的资源却相对较少。这些发现对改善 EGS 结果公平性的措施具有重要意义。
