Gatz Allison E, Xiong Chenxi, Chen Yao, Jiang Shihui, Nguyen Chi Mai, Song Qianqian, Li Xiaochun, Zhang Pengyue, Eadon Michael T, Su Jing
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
J Am Med Inform Assoc. 2024 Dec 1;31(12):2932-2939. doi: 10.1093/jamia/ocae256.
To assess the health disparities across social determinants of health (SDoH) domains for the risk of severe acidosis independent of demographical and clinical factors.
A retrospective case-control study (n = 13 310, 1:4 matching) is performed using electronic health records (EHRs), SDoH surveys, and genomics data from the All of Us participants. The propensity score matching controls confounding effects due to EHR data availability. Conditional logistic regressions are used to estimate odds ratios describing associations between SDoHs and the risk of acidosis events, adjusted for demographic features, and clinical conditions.
Those with employer-provided insurance and those with Medicaid plans show dramatically different risks [adjusted odds ratio (AOR): 0.761 vs 1.41]. Low-income groups demonstrate higher risk (household income less than $25k, AOR: 1.3-1.57) than high-income groups ($100-$200k, AOR: 0.597-0.867). Other high-risk factors include impaired mobility (AOR: 1.32), unemployment (AOR: 1.32), renters (AOR: 1.41), other non-house-owners (AOR: 1.7), and house instability (AOR: 1.25). Education was negatively associated with acidosis risk.
Our work provides real-world evidence of the comprehensive health disparities due to socioeconomic and behavioral contributors in a cohort enriched in minority groups or underrepresented populations.
SDoHs are strongly associated with systematic health disparities in the risk of severe metabolic acidosis. Types of health insurance, household income levels, housing status and stability, employment status, educational level, and mobility disability play significant roles after being adjusted for demographic features and clinical conditions. Comprehensive solutions are needed to improve equity in healthcare and reduce the risk of severe acidosis.
评估健康的社会决定因素（SDoH）各领域之间在独立于人口统计学和临床因素的严重酸中毒风险方面的健康差异。
使用来自“我们所有人”项目参与者的电子健康记录（EHR）、SDoH调查和基因组学数据进行一项回顾性病例对照研究（n = 13310，1:4匹配）。倾向得分匹配控制了由于EHR数据可用性导致的混杂效应。使用条件逻辑回归来估计描述SDoH与酸中毒事件风险之间关联的比值比，并对人口统计学特征和临床状况进行了调整。
拥有雇主提供保险的人和拥有医疗补助计划的人显示出截然不同的风险[调整后的比值比（AOR）：0.761对1.41]。低收入群体（家庭收入低于2.5万美元，AOR：1.3 - 1.57）比高收入群体（10万 - 20万美元，AOR：0.597 - 0.867）表现出更高的风险。其他高风险因素包括行动能力受损（AOR：1.32）、失业（AOR：1.32）、租房者（AOR：1.41）、其他非房主（AOR：1.7）以及住房不稳定（AOR：1.25）。教育与酸中毒风险呈负相关。
我们的研究提供了现实世界的证据，证明在一个少数民族群体或代表性不足人群丰富的队列中，社会经济和行为因素导致了全面的健康差异。
SDoH与严重代谢性酸中毒风险中的系统性健康差异密切相关。在对人口统计学特征和临床状况进行调整后，医疗保险类型、家庭收入水平、住房状况和稳定性、就业状况、教育水平以及行动能力残疾起着重要作用。需要综合解决方案来改善医疗保健公平性并降低严重酸中毒风险。
