Strauss D, Eyman R K, Grossman H J
Department of Statistics, University of California, Riverside 92521, USA.
Am J Public Health. 1996 Oct;86(10):1422-9. doi: 10.2105/ajph.86.10.1422.
This study was undertaken to assess the predictors of mortality in severely disabled children with mental retardation, and to compare risk-adjusted mortality rates for those living in institutions with rates for those living in the community.
Statistical analysis was performed on a set of 24,469 person-years, derived from a population of all children with severe mental retardation and a fragile medical condition who are registered with the California Department of Developmental Services. Variables included age, several measures of mobility, the presence or absence of tube feeding, the level of retardation, and certain adaptive skills.
Reduced mobility and the use of tube feeding were associated with a large increase in mortality risk. Own home residence and community care facilities have an estimated 25% higher risk-adjusted odds on mortality than institutions and health facilities.
The differential mortality in the placements points to a possible effect of quality of care. One consequence of the current trend toward deinstitutionalization may be an increased mortality rate in children with severe developmental disability.
本研究旨在评估重度智障残疾儿童的死亡预测因素，并比较机构养育儿童与社区养育儿童经风险调整后的死亡率。
对加利福尼亚州发展服务部登记的所有患有严重智力障碍和脆弱医疗状况的儿童群体的一组24469人年数据进行统计分析。变量包括年龄、多种活动能力指标、是否使用管饲、智障程度以及某些适应技能。
活动能力下降和使用管饲与死亡风险大幅增加相关。与机构和医疗设施相比，家庭住所和社区护理设施的经风险调整后的死亡几率估计高25%。
不同安置方式下的死亡率差异表明护理质量可能存在影响。当前去机构化趋势的一个后果可能是严重发育障碍儿童的死亡率上升。
