Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2023 Jan;75(1):22-33. doi: 10.1002/acr.25015. Epub 2022 Oct 12.
Climate and social vulnerability contribute to morbidity and health care utilization. We examined associations between the neighborhood Social Vulnerability Index (SVI) and the Heat Vulnerability Index (HVI) and recurrent hospitalizations among individuals with rheumatic conditions.
Using a Massachusetts multihospital centralized clinical data repository, we identified individuals ≥18 years of age with a rheumatic condition who received rheumatology care within 3 years of April 2021. We defined the index date as 2 years before the last encounter and the baseline period as 1 year pre-index date. Addresses were geocoded and linked by census tract to the SVI and the HVI. We used multilevel, multinomial logistic regression to examine the odds of 1-3 and ≥4 hospitalizations (reference = 0) over 2 years post index date by vulnerability index, adjusting for age, gender, race/ethnicity, insurance, and comorbidities.
Among 14,401 individuals with rheumatic conditions, the mean ± age was 61.9 ± 15.7 years, 70% were female, 79% White, 7% Black, and 2% Hispanic. There were 8,251 hospitalizations; 11,649 individuals (81%) had 0 hospitalizations, 2,063 (14%) had 1-3, and 689 (5%) had ≥4. Adjusting for individual-level factors, individuals living in the highest versus lowest SVI areas had 1.84 times higher odds (95% confidence interval [95% CI] 1.43-2.36) of ≥4 hospitalizations. Individuals living in the highest versus lowest HVI areas had 1.64 times greater odds (95% CI 1.17-2.31) of ≥4 hospitalizations.
Individuals with rheumatic conditions living in areas with high versus low social and heat vulnerability had significantly greater odds of recurrent hospitalizations. Studies are needed to determine modifiable factors to mitigate risks.
气候和社会脆弱性会导致发病和医疗保健的利用。我们研究了社区社会脆弱性指数（SVI）和热脆弱性指数（HVI）与风湿性疾病患者再住院之间的关系。
我们使用马萨诸塞州多医院集中临床数据存储库，确定了在 2021 年 4 月前的 3 年内接受过风湿病治疗的年龄≥18 岁的患有风湿性疾病的个体。我们将索引日期定义为最后一次就诊前 2 年，基准期为索引日期前 1 年。地址通过普查区进行地理编码并与 SVI 和 HVI 相关联。我们使用多级多项逻辑回归来研究脆弱性指数与 2 年后再住院（参考=0）的 1-3 次和≥4 次住院之间的比值比，调整年龄、性别、种族/族裔、保险和合并症。
在 14401 名患有风湿性疾病的个体中，平均年龄为 61.9±15.7 岁，70%为女性，79%为白人，7%为黑人，2%为西班牙裔。有 8251 次住院治疗；11649 名（81%）无住院治疗，2063 名（14%）有 1-3 次住院治疗，689 名（5%）有≥4 次住院治疗。在调整个体因素后，生活在 SVI 最高和最低地区的个体发生≥4 次住院的几率分别高出 1.84 倍（95%置信区间[95%CI]1.43-2.36）和 1.64 倍（95%CI1.17-2.31）。
与生活在社会和热脆弱性低地区的个体相比，患有风湿性疾病的个体生活在社会和热脆弱性高的地区，再住院的几率显著更高。需要进一步研究以确定可改变的因素来降低风险。
