Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, USA.
Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
Public Health Rep. 2022 Jan-Feb;137(1):110-119. doi: 10.1177/0033354921994897. Epub 2021 Mar 9.
Bacteremia is the presence of bacteria in the bloodstream. The objective of this study was to determine the relationship between low socioeconomic status (SES) and the epidemiology, process of care, and outcomes of patients with bacteremia (SAB).
We conducted a multicenter, retrospective, cohort study that evaluated adult patients with SAB in 3 Los Angeles County hospitals from July 15, 2012, through May 31, 2018. We determined SES (low SES, intermediate SES, and high SES) for each patient and compared sociodemographic and epidemiologic characteristics, management of care received by patients with SAB (ie, process of care), and outcomes. We used a Cox proportional hazards model to determine predictors of 30-day mortality for each SES group.
Of 915 patients included in the sample, 369 (40%) were in the low-SES group, 294 (32%) in the intermediate-SES group, and 252 (28%) in the high-SES group. Most significant predictors of 30-day mortality in the Cox proportional hazards model were admission to an intensive care unit (hazard ratio [HR] = 9.04; 95% CI, 4.26-19.14), Pitt bacteremia score ≥4 indicating critical illness (HR = 4.30; 95% CI, 2.49-7.44), having ≥3 comorbidities (HR = 2.05; 95% CI, 1.09-3.85), and advanced age (HR = 1.03; 95% CI, 1.01-1.05). Distance between home and admitting hospital affected mortality only in the low-SES group (HR = 1.02; 95% CI, 1.00-1.02).
SES did not independently affect the outcome of SAB; however, the farther the patient's residence from the hospital, the greater the negative effect on survival in a low-SES population. Our findings underscore the need to develop multipronged, targeted public health efforts for populations that have transportation barriers to health care.
菌血症是指细菌存在于血液中。本研究的目的是确定低社会经济地位（SES）与菌血症（SAB）患者的流行病学、治疗过程和结局之间的关系。
我们进行了一项多中心、回顾性队列研究，评估了 2012 年 7 月 15 日至 2018 年 5 月 31 日期间在洛杉矶县 3 家医院住院的成人 SAB 患者。我们确定了每位患者的 SES（低 SES、中 SES 和高 SES），并比较了 SAB 患者的社会人口统计学和流行病学特征、接受的治疗管理（即治疗过程）和结局。我们使用 Cox 比例风险模型确定每个 SES 组 30 天死亡率的预测因素。
在纳入的 915 例样本中，369 例（40%）为低 SES 组，294 例（32%）为中 SES 组，252 例（28%）为高 SES 组。Cox 比例风险模型中 30 天死亡率的主要预测因素是入住重症监护病房（危险比[HR] = 9.04；95%CI，4.26-19.14）、Pitt 菌血症评分≥4 表示病重（HR = 4.30；95%CI，2.49-7.44）、合并症≥3 种（HR = 2.05；95%CI，1.09-3.85）和年龄较大（HR = 1.03；95%CI，1.01-1.05）。家庭与住院医院之间的距离仅影响低 SES 组的死亡率（HR = 1.02；95%CI，1.00-1.02）。
SES 并未独立影响 SAB 的结局；然而，患者居住地离医院越远，对低 SES 人群的生存影响越大。我们的研究结果强调了需要为那些在获得医疗保健方面存在交通障碍的人群制定多管齐下的有针对性的公共卫生措施。
