社区社会剥夺与先天性心脏病青年患者的医疗利用、残疾和合并症：先天性心脏病调查以认识结局、需求和健康状况 2016-2019 年。
Neighborhood social deprivation and healthcare utilization, disability, and comorbidities among young adults with congenital heart defects: Congenital heart survey to recognize outcomes, needs, and well-being 2016-2019.
机构信息
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA.
出版信息
Birth Defects Res. 2023 Oct 15;115(17):1608-1618. doi: 10.1002/bdr2.2239. Epub 2023 Aug 14.
BACKGROUND
Research on the association between neighborhood social deprivation and health among adults with congenital heart defects (CHD) is sparse.
METHODS
We evaluated the associations between neighborhood social deprivation and health care utilization, disability, and comorbidities using the population-based 2016-2019 Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) of young adults. Participants were identified from active birth defect surveillance systems in three U.S. sites and born with CHD between 1980 and 1997. We linked census tract-level 2017 American Community Survey information on median household income, percent of ≥25-year-old with greater than a high school degree, percent of ≥16-year-olds who are unemployed, and percent of families with children <18 years old living in poverty to survey data and used these variables to calculate a summary neighborhood social deprivation z-score, divided into tertiles. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) derived from a log-linear regression model with a Poisson distribution estimated the association between tertile of neighborhood social deprivation and healthcare utilization in previous year (no encounters, 1 and ≥2 emergency room [ER] visits, and hospital admission), ≥1 disability, and ≥1 comorbidities. We accounted for age, place of birth, sex at birth, presence of chromosomal anomalies, and CHD severity in all models, and, additionally educational attainment and work status in all models except disability.
RESULTS
Of the 1435 adults with CHD, 43.8% were 19-24 years old, 54.4% were female, 69.8% were non-Hispanic White, and 33.7% had a severe CHD. Compared to the least deprived tertile, respondents in the most deprived tertile were more likely to have no healthcare visit (aPR: 1.5 [95% CI: 1.1, 2.1]), ≥2 ER visits (1.6 [1.1, 2.3]), or hospitalization (1.6 [1.1, 2.3]) in the previous 12 months, a disability (1.2 [1.0, 1.5]), and ≥1 cardiac comorbidities (1.8 [1.2, 2.7]).
CONCLUSIONS
Neighborhood social deprivation may be a useful metric to identify patients needing additional resources and referrals.
背景
针对成年人先天性心脏病（CHD）患者的邻里社会剥夺与健康之间的关联研究较少。
方法
我们使用基于人群的 2016-2019 年先天性心脏病调查，以识别年轻人的结果、需求和健康状况（CH STRONG），评估了邻里社会剥夺与医疗保健利用、残疾和合并症之间的关联。参与者是从美国三个地点的主动出生缺陷监测系统中确定的，并于 1980 年至 1997 年之间出生患有 CHD。我们将 2017 年美国社区调查中关于家庭中位数收入、≥25 岁具有高中以上学历的百分比、≥16 岁失业百分比和有<18 岁儿童的家庭百分比的信息与调查数据相关联，并使用这些变量计算邻里社会剥夺的综合 z 分数，分为三分位数。使用泊松分布的对数线性回归模型得出的调整后患病率比（aPR）和 95%置信区间（CI），估计了邻里社会剥夺三分位数与前一年医疗保健利用（无就诊、≥1 次急诊就诊和住院）、≥1 项残疾和≥1 项合并症之间的关联。我们在所有模型中都考虑了年龄、出生地、出生时的性别、染色体异常的存在和 CHD 严重程度，并且除了残疾以外，在所有模型中还考虑了教育程度和工作状态。
结果
在 1435 名患有 CHD 的成年人中，43.8%为 19-24 岁，54.4%为女性，69.8%为非西班牙裔白人，33.7%患有严重 CHD。与最不贫困的三分位数相比，处于最贫困三分位数的受访者在前 12 个月内更有可能没有医疗就诊（aPR：1.5[95%CI：1.1，2.1]）、≥2 次急诊就诊（1.6[1.1，2.3]）或住院（1.6[1.1，2.3]）、残疾（1.2[1.0，1.5]）和≥1 项心脏合并症（1.8[1.2，2.7]）。
结论
邻里社会剥夺可能是一种有用的指标，可以识别需要额外资源和转介的患者。
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