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社会经济劣势、居住偏远程度与脑瘫专科干预措施的可及性:一项横断面研究

Socioeconomic Disadvantage, Residential Remoteness and Access to Specialised Interventions in Cerebral Palsy: A Cross-Sectional Study.

作者信息

Paget Simon P, Stewart Kirsty, Copeland Lisa, Waight Emma, Smith Nadine, Baker Felicity, Lewis Jennifer

机构信息

Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.

Kids Rehab, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia.

出版信息

J Clin Med. 2025 May 20;14(10):3579. doi: 10.3390/jcm14103579.

Abstract

: Socioeconomic factors are known to influence access to health services, including for children with cerebral palsy (CP). This study aims to determine whether socioeconomic disadvantage and/or geographical remoteness influence access to specialised CP interventions: selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB). : This was a cross-sectional study of children with CP from (i) the Australian SDR Research Registry and (ii) an Australian ITB audit study. Socioeconomic disadvantage was grouped (quintiles) using the Index of Relative Socioeconomic Disadvantage (IRSD). Geographical remoteness was determined using the Australian Statistical Geographical Standard. IRSD quintiles and remoteness were compared with the Australian CP Register (ACPR) (birth years 1995-2016). : A total of 64 children (31.3% female) had received SDR surgery and 52 children (48.1% female) had received ITB therapy. Of these, 7 (11.1%) (SDR) and 7 (13.5%) (ITB) lived in the most disadvantaged neighbourhoods (IRSD quintile 1); 41 children (65.1%) (SDR) and 42 (82.4%) (ITB) lived in major cities. In comparison, 1630 (18.8%) of children on the ACPR resided in IRSD quintile 1; 6122 (70.4%) resided in major cities. There were no statistical differences in IRSD distribution between ACPR, SDR, and ITB groups. More children in major cities received ITB therapy ( = 0.03) and more children in outer regional/remote areas had received SDR ( = 0.03). : Access to SDR and ITB in Australia varies by geographical remoteness. Equity of access is important to monitor, and interventions should be considered to reduce inequity.

摘要

社会经济因素会影响获得医疗服务的机会,这一点在包括脑瘫(CP)儿童在内的人群中已为人所知。本研究旨在确定社会经济劣势和/或地理偏远是否会影响获得专门的脑瘫干预措施:选择性背根切断术(SDR)和鞘内注射巴氯芬(ITB)。

这是一项对来自(i)澳大利亚SDR研究登记处和(ii)澳大利亚ITB审计研究的脑瘫儿童进行的横断面研究。社会经济劣势使用相对社会经济劣势指数(IRSD)进行分组(五分位数)。地理偏远程度根据澳大利亚统计地理标准确定。将IRSD五分位数和偏远程度与澳大利亚脑瘫登记处(ACPR)(出生年份1995 - 2016年)进行比较。

共有64名儿童(31.3%为女性)接受了SDR手术,52名儿童(48.1%为女性)接受了ITB治疗。其中,7名(11.1%)(SDR)和7名(13.5%)(ITB)生活在最贫困社区(IRSD五分位数1);41名儿童(65.1%)(SDR)和42名(82.4%)(ITB)生活在大城市。相比之下,ACPR上1630名(18.8%)儿童居住在IRSD五分位数1;6122名(70.4%)居住在大城市。ACPR、SDR和ITB组之间在IRSD分布上没有统计学差异。大城市中接受ITB治疗的儿童更多( = 0.03),外地区域/偏远地区接受SDR的儿童更多( = 0.03)。

在澳大利亚,获得SDR和ITB的机会因地理偏远程度而异。监测获得医疗服务的公平性很重要,应考虑采取干预措施以减少不公平现象。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/307e/12112737/80247bae41ad/jcm-14-03579-g001.jpg

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