McConnochie K M, Roghmann K J, Liptak G S
Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA.
Pediatrics. 1997 Jun;99(6):774-84. doi: 10.1542/peds.99.6.774.
To examine geographic variation in rates of infant hospitalization for diagnoses classified by type of hospitalization decision in Monroe County (Rochester), New York.
Study design was cross-sectional and ecologic. International Classification of Diseases (ICD) codes were used to categorize all 7883 hospitalizations for infants (age, <24 months) beyond the newborn period between 1985 and 1991. Postal zip codes defined socioeconomic areas as inner-city, other urban, and suburban for the population at risk. In 1990, inner-city infants included 62% black and 65% Medicaid-covered infants, whereas suburban infants included 3% black and 6% covered by Medicaid. Hospitalization rates were compared among the three socioeconomic areas.
Overall hospitalization rate was 50.3 per 1000 child years. Admissions classified as discretionary accounted for 59% of these, followed by those classified as mandatory, 18%; sometime (congenital heart disease, cleft palate), 15%; discretionary surgery (inguinal hernia, tonsillectomy/adenoidectomy), 6%; and unlikely to need admission, 2%. A stepwise, socioeconomic gradient in hospitalization was found, with rates of 38.1, 51.3, and 82.9 per 1000 child-years, respectively, for suburban, other urban, and inner-city areas. Rates for discretionary, unlikely, and mandatory admissions followed this gradient. Using the odds for hospitalization of suburban infants as the base odds, the odds ratio for discretionary hospitalization for inner-city infants was 2.88 (95% confidence interval [CI], 2.69 to 3. 08) and that for mandatory hospitalization was 2.20 (95% CI, 1.94 to 2.49). In multiple regression analysis, low education level of mothers explained 81% of the variance in discretionary hospitalization rate. Although the per capita rate of hospital care of inner-city infants was more than twofold greater than that for suburban infants, potential for reducing this difference is suggested by the fact that discretionary admissions accounted for 78. 9% of this difference, whereas mandatory admissions accounted for 17. 7% of the difference.
The hospitalization rate for inner-city infants is much greater than that for suburban infants. A substantial portion of the difference, namely that attributable to mandatory admissions, reflected higher rates of serious illness. Differences attributable to discretionary admissions may reflect higher rates of serious illness to some extent, but also appear to reflect less effective health services to a substantial degree.
研究纽约州门罗县（罗切斯特市）按住院决策类型分类的婴儿住院率的地理差异。
研究设计为横断面生态学研究。使用国际疾病分类（ICD）编码对1985年至1991年间新生儿期后所有7883例婴儿（年龄小于24个月）的住院情况进行分类。邮政编码将社会经济区域定义为内城区、其他城区和郊区的高危人群。1990年，内城区婴儿中62%为黑人，65%有医疗补助；而郊区婴儿中3%为黑人，6%有医疗补助。比较了三个社会经济区域的住院率。
总体住院率为每1000儿童年50.3例。分类为可自由决定的住院占其中的59%，其次是强制住院，占18%；有时（先天性心脏病、腭裂），占15%；选择性手术（腹股沟疝、扁桃体切除术/腺样体切除术），占6%；不太可能需要住院，占2%。发现住院存在逐步的社会经济梯度，郊区、其他城区和内城区的住院率分别为每1000儿童年38.1例、51.3例和82.9例。可自由决定、不太可能和强制住院的比率也遵循这一梯度。以郊区婴儿住院的比值为基础比值，内城区婴儿可自由决定住院的比值比为2.88（95%置信区间[CI]，2.69至3.08），强制住院的比值比为2.20（95%CI，1.94至2.49）。在多元回归分析中，母亲教育水平低解释了可自由决定住院率差异的81%。尽管内城区婴儿的人均住院治疗率比郊区婴儿高出两倍多，但可自由决定的住院占这一差异的78.9%，而强制住院占差异的17.7%，这表明有可能缩小这一差距。
内城区婴儿的住院率远高于郊区婴儿。差异的很大一部分，即归因于强制住院的部分，反映了重病率较高。归因于可自由决定住院的差异在一定程度上可能反映了重病率较高，但在很大程度上似乎也反映了卫生服务效果较差。
