Wong Jonathan P, Runeckles Kyle, Manlhiot Cedric, O'Shea Sunita, Collins Tanveer, Bernknopf Bailey, Farid Pedrom, Chahal Nita, McCrindle Brian W
Department of Pediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
CJC Pediatr Congenit Heart Dis. 2022 Nov 1;1(6):248-252. doi: 10.1016/j.cjcpc.2022.10.007. eCollection 2022 Dec.
For patients with Kawasaki disease (KD), lower socioeconomic status (SES) may adversely affect the timeliness of presentation and initiation of intravenous immune globulin, and coronary artery outcomes. Multipayer systems have been shown to affect health care equity and access to health care negatively. We sought to determine the association of SES with KD outcomes in a single-payer health care system.
Patients with KD presenting from 2007 to 2017 at a single institution were included. SES data were obtained by matching patient postal code district with data from the 2016 Census Canada.
SES data were linked for 1018 patients. The proportion of households living below the after-tax low-income cutoff in the patient's postal code district was 13% for not treated, 13% for delayed intravenous immune globulin treatment, and 12% for prompt treatment ( = 0.58). Likewise, the average median annual household income was unrelated to delayed or no treatment. The percentage >15 years of age with advanced education differed between groups at 33%, 29%, and 31% for delayed treatment, prompt treatment, and missed groups, respectively ( = 0.004). SES variables were not significantly different for those with vs without coronary artery aneurysms (max Z-score: >2.5), including the proportion of households living below low-income cutoff (12% vs 13%; = 0.37), average median annual household income (CAD$81,220 vs $82,055; = 0.78), and proportion with a university degree (33% vs 31%; = 0.49), even after adjusting for sex, age, year, and KD type.
Timeliness of treatment for KD and coronary artery outcomes were not associated with SES variables within a single-payer health care system.
对于川崎病（KD）患者，较低的社会经济地位（SES）可能会对就诊及时性、静脉注射免疫球蛋白的起始治疗以及冠状动脉结局产生不利影响。多层医疗系统已被证明会对医疗保健公平性和医疗服务可及性产生负面影响。我们试图在单一支付者医疗保健系统中确定SES与KD结局之间的关联。
纳入2007年至2017年在单一机构就诊的KD患者。通过将患者邮政编码区与2016年加拿大人口普查数据相匹配来获取SES数据。
为1018例患者关联了SES数据。患者邮政编码区中生活在税后低收入临界值以下的家庭比例，未治疗组为13%，静脉注射免疫球蛋白治疗延迟组为13%，及时治疗组为12%（P = 0.58）。同样，家庭年均收入中位数与治疗延迟或未治疗无关。延迟治疗组、及时治疗组和未治疗组中年龄>15岁且接受高等教育的百分比分别为33%、29%和31%（P = 0.004）。有冠状动脉瘤与无冠状动脉瘤患者的SES变量无显著差异（最大Z值：>2.5），包括生活在低收入临界值以下的家庭比例（12%对13%；P = 0.37）、家庭年均收入中位数（81,220加元对82,055加元；P = 0.78）以及拥有大学学位的比例（33%对31%；P = 0.49），即使在对性别、年龄、年份和KD类型进行调整后也是如此。
在单一支付者医疗保健系统中，KD的治疗及时性和冠状动脉结局与SES变量无关。
