Chhoda Ankit, Liyen Cartelle Anabel, Manoj Matthew Antony, Noriega Marco, Anderson Kelsey, Zuberi Shaharyar A, Sur Alana, Olivares Miriam, Kelly Jill, Freedman Steven D, Galler Rabinowitz Loren, Sheth Sunil G
Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Am J Med. 2025 May;138(5):827-834. doi: 10.1016/j.amjmed.2024.12.026. Epub 2024 Dec 31.
Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis.
This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability).
In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.
We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.
地理空间分析整合了基于地理位置的社会人口数据,为研究社会决定因素对急性胰腺炎结局的影响提供了一种有前景的方法。本研究旨在探讨社会脆弱性指数(SVI)及其在4个领域(社会经济地位、家庭构成与残疾、少数族裔地位与语言、住房类型与交通)的16个构成属性与急性胰腺炎患者结局之间的关联。
本研究纳入了2008年1月1日至2021年12月31日期间住院的急性胰腺炎患者,并记录了他们的人口统计学信息和临床结局。将实际地址进行地理编码以确定SVI,这是一个综合变量,经过排序并分为四分位数(I-IV:IV代表最高脆弱性)。
在824例符合条件的患者[年龄53.0±10岁,女性占48.2%]中,有993次与急性胰腺炎相关的住院治疗,我们注意到居住在SVI较高社区的患者存在显著关联,无保险/联邦/州保险的患病率较高(P<.001)以及未得到充分服务的族裔/种族背景(P<.001)。尽管对年龄、体重指数和合并症进行了调整,但我们观察到居住在SVI较高地区的患者出现酒精戒断的显著关联(优势比:1.62[95%CI:1.19-2.22];P=.003)。然而,我们未观察到SVI与急性胰腺炎严重程度、住院期间阿片类药物使用、住院时间、30天再入院率及死亡率之间存在关联。
我们注意到居住在SVI排名较高地区的患者酒精戒断显著更高,尽管在急性胰腺炎严重程度、住院期间阿片类药物使用、住院时间、30天再入院率及死亡率方面没有差异。