Quinn Nicholas, Gupta Neeru
Dalhousie Medicine New Brunswick, P.O. Box 5050, Saint John, NB, Canada.
Int J Popul Data Sci. 2020 Oct 22;5(3):1370. doi: 10.23889/ijpds.v5i3.1388.
Hospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease. Research has pointed to disparities in various COPD-related outcomes between persons of lower versus higher income; however, few studies have examined the influence of patients' social context on potentially avoidable COPD admissions.
The research explores the use of linked population census and administrative health data to assess the influence of income inequalities on the risk of hospitalization and rehospitalization for COPD among Canadian adults.
This analysis utilizes data from the 2006 Census linked longitudinally to the 2006/07-2008/09 Discharge Abstract Database. Multiple logistic regressions were conducted to assess the independent influence of income inequality on the risks of hospitalization and of six-month readmission due to COPD among the population aged 30-69, controlling for age, sex, education and other sociodemographic characteristics.
Compared with adults in the most affluent income quintile, the adjusted odds of COPD hospitalization were significantly greater in the 4th highest income quintile (OR: 1.38; 95%CI: 1.30-1.47), and peaked for those in the least affluent quintile (OR: 2.92; 95%CI: 2.77-3.09). Among individuals who had been hospitalized at least once for COPD in the study period, and compared with the most affluent group, the adjusted odds of readmission were highest in the least affluent group (OR: 1.39; 95%CI: 1.22-1.58).
Despite Canada's system of universal coverage for physician and hospital care, a clear income gradient in the risk of being hospitalized and, to some extent, rehospitalized for COPD, is found. Income inequalities may be contributing to excess hospitalizations, reinforcing the importance of integrating social and economic issues in primary care to meet the ambulatory needs of this population.
因门诊护理敏感型疾病而住院的情况，其中慢性阻塞性肺疾病（COPD）最为常见，这是医疗系统管理慢性病的一项间接指标。研究表明，低收入人群和高收入人群在各种与慢性阻塞性肺疾病相关的结果方面存在差异；然而，很少有研究考察患者的社会环境对潜在可避免的慢性阻塞性肺疾病住院的影响。
本研究探讨利用人口普查与行政卫生数据相链接的方式，评估收入不平等对加拿大成年人慢性阻塞性肺疾病住院和再住院风险的影响。
本分析使用了2006年人口普查数据，并与2006/07 - 2008/09年出院摘要数据库进行纵向链接。进行了多项逻辑回归分析，以评估收入不平等对30 - 69岁人群因慢性阻塞性肺疾病住院和六个月内再住院风险的独立影响，并对年龄、性别、教育程度和其他社会人口学特征进行了控制。
与收入最高的五分之一人群中的成年人相比，收入第四高的五分之一人群中慢性阻塞性肺疾病住院的调整后比值显著更高（比值比：1.38；95%置信区间：1.30 - 1.47），而在最贫困的五分之一人群中达到峰值（比值比：2.92；95%置信区间：2.77 - 3.09）。在研究期间因慢性阻塞性肺疾病至少住院一次的个体中，与最富裕的群体相比，最贫困群体的再住院调整后比值最高（比值比：1.39；95%置信区间：1.22 - 1.58）。
尽管加拿大实行了医生和医院护理全民覆盖制度，但仍发现因慢性阻塞性肺疾病住院以及在一定程度上再住院的风险存在明显的收入梯度。收入不平等可能导致住院人数过多，这凸显了将社会和经济问题纳入初级保健以满足该人群门诊需求的重要性。
