A. García-Martínez, L. Artajona, G. Osorio, E. Bragulat, S. Aguiló
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Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes.</p></div><div><h3>Results</h3><p>The cohort included 553 patients (80 years [73–85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio<!--> <!-->=<!--> <!-->0.654 (95% CI 0.441–0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio<!--> <!-->=<!--> <!-->2.739; 95% CI 1.470–5.104). 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引用次数: 0
摘要
引言和目的：社会经济地位低（SES）与健康状况差有关。本研究旨在调查急诊科就诊的老年患者的社会经济地位是否与医疗资源的使用和结果有关：观察性、回顾性研究，包括急诊科连续收治的 65 岁及以上患者。研究记录了基线、指数发作和随访时的变量。SES采用间接理论指数进行测量，根据患者居住的社区SES是低还是高，将患者分为两组。主要结果包括急诊室就诊后的住院情况和指数发病时的长期住院情况（>7 天）。次要结果包括发病后 3 个月内急诊科再次就诊和入院情况，以及长期随访后的全因死亡率。研究采用逻辑回归和累积危险度回归模型来探讨社会经济地位与结果之间的关系：研究对象包括 553 名患者（80 岁 [73-85]，50.5% 为女性，55.9% 为社会经济地位低下者）。在急诊就诊后，234 名患者（42.3%）需要入院治疗。低社会经济地位与住院治疗成反比，调整后的几率比=0.654（95% CI 0.441-0.970）。在住院患者中，低社会经济地位与住院时间延长有关（调整后的几率比=2.739；95% CI 1.470-5.104）。随访结果（包括全因死亡率）与社会经济地位无关：结论：生活在较贫困城市地区的老年患者在接受急诊科治疗后住院的频率较低，但住院时间较长。了解社会决定因素对医疗服务使用的影响对于根据患者需求调整资源至关重要。
Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study
Introduction and objective
A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes.
Patients and methods
Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes.
Results
The cohort included 553 patients (80 years [73–85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio = 0.654 (95% CI 0.441–0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio = 2.739; 95% CI 1.470–5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES.
Conclusions
Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.
期刊介绍：
Revista de Calidad Asistencial (Quality Healthcare) (RCA) is the official Journal of the Spanish Society of Quality Healthcare (Sociedad Española de Calidad Asistencial) (SECA) and is a tool for the dissemination of knowledge and reflection for the quality management of health services in Primary Care, as well as in Hospitals. It publishes articles associated with any aspect of research in the field of public health and health administration, including health education, epidemiology, medical statistics, health information, health economics, quality management, and health policies. The Journal publishes 6 issues, exclusively in electronic format. The Journal publishes, in Spanish, Original works, Special and Review Articles, as well as other sections. Articles are subjected to a rigorous, double blind, review process (peer review)
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