Connell F A, Day R W, LoGerfo J P
Am J Public Health. 1981 Jun;71(6):606-13. doi: 10.2105/ajph.71.6.606.
Population-based hospitalization rates were computed and analyzed for AFDC children among 14 small area subdivisions of the State of Washington. Medical-surgical admission rates ranged from 65.3 to 161.7 per 1,000 person-years among the 14 areas. Surgical admission rates were significantly higher in urban areas; medical admission rates were significantly higher in rural areas. The majority of variance in overall rates was accounted for by admissions for four diagnostic categories: gastroenteritis (18-fold differences), lower respiratory infections (15-fold differences), upper respiratory infections (8-fold differences), and ear, nose, and throat (ENT) surgery (6-fold differences). Secondary analysis indicates that these differences in admission rates were not associated with: medical need or demographic factors, epidemic patterns of disease, physician supply, hospital bed supply or occupancy rates, or severity of disease or delay in seeking medical care as reflected by average length of stay. It is possible that the observed variations may reflect either differences in the propensity of local physicians to hospitalize or differences in the use or adequacy of community, ambulatory, and preventive care.
计算并分析了华盛顿州14个小区域细分中接受“对有受抚养子女家庭的援助”（AFDC）儿童的基于人群的住院率。在这14个区域中，内科-外科住院率为每1000人年65.3至161.7例。城市地区的外科住院率显著更高；农村地区的内科住院率显著更高。总体住院率的大部分差异是由四类诊断的住院情况导致的：肠胃炎（相差18倍）、下呼吸道感染（相差15倍）、上呼吸道感染（相差8倍）以及耳鼻喉（ENT）手术（相差6倍）。二次分析表明，这些住院率差异与以下因素无关：医疗需求或人口统计学因素、疾病流行模式、医生供应、医院床位供应或占用率，以及疾病严重程度或因平均住院时间所反映的就医延迟情况。观察到的差异可能反映了当地医生住院倾向的差异，或者社区、门诊和预防保健使用情况或充分性的差异。
