无医疗利用和死亡。
No Healthcare Utilization and Death.
机构信息
Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan.
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan.
出版信息
J Gen Intern Med. 2022 May;37(7):1648-1657. doi: 10.1007/s11606-021-07138-0. Epub 2021 Sep 29.
BACKGROUND
An inappropriately low frequency of healthcare utilization has been reported to be associated with poor control of chronic diseases, accelerating healthcare disparities. However, the evidence is limited regarding the association between no healthcare utilization and mortality.
OBJECTIVES
To examine whether individuals without healthcare utilization have the increased risks of mortality among the US general population.
DESIGN
Prospective cohort study PARTICIPANTS: Adults aged ≥ 20 years (n = 39,067) in the National Health and Nutrition Examination Survey (NHANES)1999-2014 linked to national mortality data through December 2015.
MAIN MEASURES
The exposure was the number of visits to healthcare providers during the past year (healthcare utilization): none, 1-3 times (referent), 4-9 times, or ≥ 10 times. Cox hazard regression models were employed to estimate the adjusted hazard ratios (aHR) of all-cause, cardiovascular, and cancer mortality adjusting for socio-demographic characteristics and comorbidities.
KEY RESULTS
During a median follow-up of 7.4 years, participants without visit over the past year showed higher risks of all-cause mortality (aHR [95% CI] = 1.16 [1.04-1.30]) and cardiovascular mortality (aHR [95% CI] = 1.62 [1.28-2.05]) than those who visited the office 1-3 times. We found no evidence of the association between no visit and cancer mortality. The association between no providers' office visit and all-cause mortality was stronger among males (aHR [95% CI] = 1.22 [1.06-1.40]) than females (aHR [95% CI] = 0.97 [0.79-1.19]; p-for-interaction = 0.01) and among uninsured individuals (aHR [95% CI] = 1.22 [0.98-1.51]) than insured individuals (aHR [95% CI] = 1.09 [0.95-1.25]; p-for-interaction = 0.04).
CONCLUSION
No providers' office visit over a year was associated with increased risks of all-cause and cardiovascular mortality. Further investigations are warranted to identify the underlying reasons for the elevated mortality risks due to no healthcare utilization.
背景
有报道称，医疗保健利用频率不当与慢性病控制不佳有关，从而加速了医疗保健差距的扩大。然而，关于无医疗保健利用与死亡率之间的关联，证据有限。
目的
检查在美国普通人群中，无医疗保健利用的个体是否具有更高的死亡风险。
设计
前瞻性队列研究
参与者
国家健康和营养检查调查（NHANES）1999-2014 年中年龄≥20 岁的成年人（n=39067），通过 2015 年 12 月的国家死亡率数据与全国死亡率数据相关联。
主要措施
暴露因素是过去一年中去医疗保健提供者就诊的次数（医疗保健利用）：无就诊（参照组）、1-3 次就诊、4-9 次就诊或≥10 次就诊。采用 Cox 危害回归模型，根据社会人口统计学特征和合并症，估计全因、心血管和癌症死亡率的调整危害比（aHR）。
主要结果
在中位数为 7.4 年的随访期间，过去一年无就诊的参与者全因死亡率（aHR[95%CI]=1.16[1.04-1.30]）和心血管死亡率（aHR[95%CI]=1.62[1.28-2.05]）的风险均高于就诊 1-3 次的参与者。我们没有发现无就诊与癌症死亡率之间存在关联的证据。无医疗保健提供者办公室就诊与全因死亡率之间的关联在男性中更强（aHR[95%CI]=1.22[1.06-1.40]），而在女性中则较弱（aHR[95%CI]=0.97[0.79-1.19]；p 交互=0.01），在未参保个体中（aHR[95%CI]=1.22[0.98-1.51]）高于参保个体（aHR[95%CI]=1.09[0.95-1.25]；p 交互=0.04）。
结论
过去一年无医疗保健提供者办公室就诊与全因和心血管死亡率增加相关。需要进一步研究以确定由于无医疗保健利用而导致的死亡率升高的潜在原因。
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