2002年至2021年新南威尔士州公立医院收治的心力衰竭患者中，基于地理位置偏远程度的院内死亡率差异：一项回顾性观察队列研究。

Geographic remoteness-based differences in in-hospital mortality among people admitted to NSW public hospitals with heart failure, 2002-21: a retrospective observational cohort study.

作者信息

Rubenis Imants, Harvey Gregory, Hyun Karice, Chow Vincent, Kritharides Leonard, Sindone Andrew P, Brieger David B, Ng Austin Cc

机构信息

Concord Repatriation General Hospital, Sydney, NSW.

The University of Sydney, Sydney, NSW.

出版信息

Med J Aust. 2025 Apr 21;222(7):348-355. doi: 10.5694/mja2.52635.

DOI:10.5694/mja2.52635

PMID:40253641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12009594/

Abstract

OBJECTIVE

To examine associations between remoteness of region of residence and in-hospital mortality for people admitted to hospital with heart failure in New South Wales during 2002-21.

STUDY DESIGN

Retrospective observational cohort study; analysis of New South Wales Admitted Patient Data Collection data.

SETTING, PARTICIPANTS: Adult (16 years or older) NSW residents admitted with heart failure to NSW public hospitals, 1 January 2002 - 30 September 2021. Only first admissions with heart failure during the study period were included.

MAIN OUTCOME MEASURES

In-hospital mortality, by remoteness of residence (Australian Statistical Geography Standard), adjusted for age (with respect to median), sex, socio-economic status (Index of Relative Socioeconomic Advantage and Disadvantage [IRSAD], with respect to median), other diagnoses, hospital length of stay, and calendar year of admission (by 4-year group).

RESULTS

We included 154 853 admissions with heart failure; 99 687 people lived in metropolitan areas (64.4%), 41 953 in inner regional areas (27.1%), and 13 213 in outer regional/remote/very remote areas (8.5%). The median age at admission was 80.3 years (interquartile range [IQR], 71.2-86.8 years), and 78 591 patients were men (50.8%). The median IRSAD score was highest for people from metropolitan areas (metropolitan: 1000; IQR, 940-1064; inner regional: 934; IQR, 924-981; outer regional/remote/very remote areas: 930; IQR, 905-936). During 2002-21, 9621 people (6.2%) died in hospital; the proportion was 8.0% in 2002, 4.9% in 2021. In-hospital all-cause mortality was lower during 2018-21 than during 2002-2005 (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.49-0.56); the decline was similar for all three remoteness categories. Compared with people from metropolitan areas, the odds of in-hospital death during 2002-21 were higher for people from inner regional (aOR, 1.12; 95% CI, 1.07-1.17) or outer regional/remote/very remote areas (aOR, 1.35; 95% CI, 1.25-1.45).

CONCLUSION

In-hospital mortality during heart failure admissions to public hospitals declined across NSW during 2002-21. However, it was higher among people living in regional and remote areas than for people from metropolitan areas. The reasons for the difference in in-hospital mortality should be investigated.

摘要

目的

研究2002年至2021年期间，新南威尔士州因心力衰竭入院患者的居住地区偏远程度与住院死亡率之间的关联。

研究设计

回顾性观察队列研究；对新南威尔士州住院患者数据收集数据进行分析。

设置、参与者：2002年1月1日至2021年9月30日期间，因心力衰竭入住新南威尔士州公立医院的成年（16岁及以上）新南威尔士州居民。仅纳入研究期间首次因心力衰竭入院的患者。

主要观察指标

按居住地区偏远程度（澳大利亚统计地理标准）划分的住院死亡率，并根据年龄（相对于中位数）、性别、社会经济地位（相对社会经济优势和劣势指数[IRSAD]，相对于中位数）、其他诊断、住院时间和入院日历年份（按4年组）进行调整。

结果

我们纳入了154853例心力衰竭入院病例；99687人居住在大都市地区（64.4%），41953人居住在内陆地区（27.1%），13213人居住在外围地区/偏远/非常偏远地区（8.5%）。入院时的中位年龄为80.3岁（四分位间距[IQR]，71.2 - 86.8岁），78591例患者为男性（50.8%）。大都市地区人群的IRSAD中位数得分最高（大都市地区：1000；IQR，940 - 1064；内陆地区：934；IQR，924 - 981；外围地区/偏远/非常偏远地区：930；IQR，905 - 936）。在2002年至2021年期间，9621人（6.2%）在医院死亡；2002年的比例为8.0%，2021年为4.9%。2018年至2021年期间的住院全因死亡率低于2002年至2005年期间（调整后的优势比[aOR]，0.52；95%置信区间[CI]，0.49 - 0.56）；所有三个偏远程度类别中的下降情况相似。与大都市地区的人群相比，2002年至2021年期间，内陆地区（aOR，1.12；95% CI，1.07 - 1.17）或外围地区/偏远/非常偏远地区（aOR，1.35；95% CI，1.25 - 1.45）的人群住院死亡几率更高。