社会经济地位与急诊科老年患者住院需求的关联：一项回顾性队列研究。

Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study.

机构信息

Emergency Medicine, Hospital Clínic, IDIBAPS, Barcelona, Spain.

出版信息

J Healthc Qual Res. 2024 May-Jun;39(3):139-146. doi: 10.1016/j.jhqr.2024.02.003. Epub 2024 Mar 27.

DOI:10.1016/j.jhqr.2024.02.003

PMID:38538438

Abstract

INTRODUCTION AND OBJECTIVE

A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes.

PATIENTS AND METHODS

Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes.

RESULTS

The cohort included 553 patients (80 years [73-85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441-0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470-5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES.

CONCLUSIONS

Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.

摘要

介绍和目的

低社会经济地位（SES）与健康状况不佳有关。本研究旨在调查老年患者在急诊科就诊时的 SES 是否与医疗资源的使用和结果有关。

患者和方法

这是一项观察性、回顾性研究，纳入了连续就诊于急诊科的 65 岁及以上的患者。记录基线、指数期和随访期的变量。SES 通过间接理论指数进行测量，并根据患者居住的社区 SES 高低将其分为两组。主要结局包括急诊科就诊后住院和指数期住院时间延长（>7 天）。次要结局包括急诊科就诊后 3 个月内再次就诊和住院、以及长期随访后的全因死亡率。使用逻辑回归和累积风险回归模型来研究 SES 与结局之间的关系。

结果

该队列包括 553 名患者（80 岁[73-85]，50.5%女性，55.9% SES 较低）。急诊科就诊后，234 名患者（42.3%）需要住院治疗。SES 较低与住院治疗呈负相关，调整后的优势比为 0.654（95%CI 0.441-0.970）。在住院患者中，SES 较低与住院时间延长相关（调整后的优势比为 2.739；95%CI 1.470-5.104）。随访结局，包括全因死亡率，与 SES 无关。