Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont.
CMAJ Open. 2022 Jun 7;10(2):E491-E499. doi: 10.9778/cmajo.20210194. Print 2022 Apr-Jun.
Some jurisdictions experience sociodemographic disparities in atopic dermatitis care, including emergency department visits, but data from Canada are limited. Our objectives were to estimate the prevalence of atopic dermatitis in Ontario and to identify sociodemographic factors associated with emergency department visits and hospitalizations for this condition.
We conducted a cross-sectional analysis of patients in the Electronic Medical Record Primary Care database linked with administrative health data for Ontario, Canada. We estimated period prevalence and health service utilization for atopic dermatitis from 2005 to 2015. We used multivariable log-binomial regression to calculate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for associations between local dermatologist density and the proportion of emergency department visits and hospitalizations for atopic dermatitis.
Among 249 984 patients, we identified 7812 with atopic dermatitis (period prevalence 2005-2015: 3.1%). Almost all physician visits for atopic dermatitis were to primary care physicians (> 99%). For every additional dermatologist per 100 000 population, the proportions of emergency department visits and hospitalizations for atopic dermatitis increased by 29% (RR 1.29, 95% CI 1.05-1.57). This relationship occurred in and around Toronto but was not consistent across the province.
In Ontario, higher dermatologist density was not associated with lower emergency department utilization and hospitalization for atopic dermatitis; the association varied in different locales with similar dermatologist densities. Strategies to improve access to care for atopic dermatitis should be tailored to local contexts.
一些司法管辖区在特应性皮炎的护理方面存在社会人口统计学差异，包括急诊科就诊，但加拿大的数据有限。我们的目的是估计安大略省特应性皮炎的患病率，并确定与该疾病急诊科就诊和住院相关的社会人口学因素。
我们对加拿大安大略省电子病历初级保健数据库与行政健康数据进行了横断面分析。我们估计了 2005 年至 2015 年期间特应性皮炎的时期患病率和卫生服务利用情况。我们使用多变量对数二项式回归计算了当地皮肤科医生密度与特应性皮炎急诊科就诊和住院比例之间的关联的调整风险比 (RR) 和 95%置信区间 (CI)。
在 249984 名患者中，我们确定了 7812 名特应性皮炎患者（2005-2015 年期间患病率：3.1%）。几乎所有特应性皮炎的就诊都是在初级保健医生那里（>99%）。每增加 100000 人口中的 1 名皮肤科医生，特应性皮炎的急诊科就诊和住院比例增加 29%（RR 1.29，95%CI 1.05-1.57）。这种关系发生在多伦多及其周边地区，但在全省范围内并不一致。
在安大略省，皮肤科医生密度较高与特应性皮炎急诊科就诊和住院率降低无关；在具有相似皮肤科医生密度的不同地区，这种关联存在差异。改善特应性皮炎护理的策略应根据当地情况进行调整。
