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初级保健中最脆弱的人群有哪些?韩国不同类型残疾个体的可避免住院情况。

Who are the most vulnerable populations for primary care? Avoidable hospitalizations across individuals with different types of disabilities in South Korea.

作者信息

Kim S, Jeon B

机构信息

Korea Institute for Health and Social Affairs, Republic of Korea.

Department of Health and Medical Information, Myongji College, Republic of Korea.

出版信息

Public Health. 2023 Apr;217:138-145. doi: 10.1016/j.puhe.2023.01.034. Epub 2023 Mar 6.

Abstract

BACKGROUND

Individuals with disabilities have limited access to primary care, the quality of care must be examined.

OBJECTIVE

To examine avoidable hospitalizations among individuals with disabilities and determine the most vulnerable populations across types of disabilities.

METHODS

Using the Korean National Health Insurance Claims Database, we compared hypertension- and diabetes-related avoidable hospitalizations (HRAH and DRAH, respectively) across disability status and disability type based on age-sex standardized rates from 2011 to 2020 and logistic regression.

RESULTS

The gap between those with and without disabilities in age-sex standardized HRAH and DRAH increased over 10 years. Odds ratios for HRAH were higher for those with disabilities, with individuals with mental disabilities having the highest odds ratio, followed by those with intellectual/developmental disabilities, then those with physical disabilities; for DRAH, the three highest odds ratios belonged to individuals with mental, intellectual/developmental, and visual disabilities. Among those with disabilities, HRAH was higher for those with mental, intellectual/developmental, and severe physical disabilities, whereas DRAH was higher for those with mental, severe visual, and intellectual/developmental disabilities compared to those with mild physical disabilities.

CONCLUSION

This study reveals high avoidable hospitalization rates among individuals with disabilities and calls for policies supporting quality primary care and comprehensively addressing disparities.

摘要

背景

残疾人获得初级保健的机会有限,因此必须对医疗质量进行检查。

目的

研究残疾人中可避免的住院情况,并确定各类残疾中最脆弱的人群。

方法

利用韩国国民健康保险索赔数据库,我们根据2011年至2020年的年龄性别标准化率和逻辑回归,比较了不同残疾状况和残疾类型下与高血压和糖尿病相关的可避免住院情况(分别为HRAH和DRAH)。

结果

在10年期间,有残疾和无残疾者在年龄性别标准化的HRAH和DRAH方面的差距有所增加。残疾人的HRAH比值比更高,其中精神残疾者的比值比最高,其次是智力/发育残疾者,然后是身体残疾者;对于DRAH,比值比最高的三类人群是精神、智力/发育和视力残疾者。在残疾人中,精神、智力/发育和严重身体残疾者的HRAH较高,而与轻度身体残疾者相比,精神、严重视力和智力/发育残疾者的DRAH较高。

结论

本研究揭示了残疾人中可避免住院率较高的情况,并呼吁制定支持优质初级保健和全面解决差距问题的政策。

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