Emerson Philip, Green David R, Stott Steve, Maclennan Graeme, Campbell Marion K, Jansen Jan O
University of Aberdeen, Aberdeen, UK.
Department of Geography and Environment, University of Aberdeen, Aberdeen, UK.
J Intensive Care Soc. 2021 May;22(2):127-135. doi: 10.1177/1751143720914462. Epub 2020 Mar 27.
There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes.
This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag-York-Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes.
A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality.
Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.
越来越多的证据表明，获得重症监护服务的机会并不公平。我们旨在调查苏格兰的居住地点是否会影响入住重症监护病房的风险及治疗结果。
这是一项基于人群的贝叶斯空间分析，研究对象为2011年1月至2015年12月期间在苏格兰入住重症监护病房的成年患者。我们使用了贝萨格 - 约克 - 莫利模型，该模型使我们能够直接对不同地区入住重症监护病房的风险及治疗结果进行概率比较。
共纳入17596名患者。年龄和性别标准化的五年入住率为每10万居民352例。该国东北部有一组议会区的调整后入住率低于苏格兰平均水平。苏格兰东南部的米德洛锡安郡的空间调整后入住率高于苏格兰平均水平。没有证据表明死亡率存在地理差异。
苏格兰获得重症监护服务的机会因居住地点而异。可能的原因包括不同的合并症负担、服务提供情况以及获得重症监护服务的机会。相比之下，如果入住重症监护病房，存活的概率并未显示出地理差异。
