比较邻里劣势指数对儿科院外急诊急救措施和结果的影响。

IF 3 3区 医学 Q1 PEDIATRICS Academic Pediatrics Pub Date : 2024-10-11 DOI:10.1016/j.acap.2024.10.004
Sriram Ramgopal, Samaa Kemal, Megan M Attridge, Remle Crowe, Christian Martin-Gill, Michelle L Macy
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引用次数: 0

摘要

目的:衡量邻里劣势的指标与儿童的健康结果存在相关性。我们将不同的邻里劣势指数与儿童紧急医疗服务(EMS)干预措施进行了比较:方法:我们对儿童急救医疗服务进行了一项回顾性研究:我们纳入了 738 892 次就诊。这些指数之间的相关性显示出良好的一致性(类内相关系数=0.75)。无论是将 COI、ADI 还是 SVI 视作拼接预测因子,还是将每个指数的第三四分位数与较低的四分位数(最弱势)进行比较,它们与每个研究结果之间的关系都存在重叠。例如,COI 的非运输 OR 为 1.12(95% 置信区间[CI]:1.10-1.14),ADI 为 1.18(95% 置信区间:1.16-1.20),SVI 为 1.22(95% 置信区间:1.20-1.23):COI、ADI 和 SVI 具有良好的相关性,对各种临床结果的影响大小估计值相似。虽然研究人员在选择邻里劣势指数时应考虑结果的潜在因果关系,但每个指数与所有结果之间的相对关联强度相似。
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Comparison of Neighborhood Disadvantage Indices on Emergency Medical Services Interventions and Outcomes for Pediatric Out-of-Hospital Emergencies.

Objective: Measures of neighborhood disadvantage demonstrate correlations to health outcomes in children. We compared differing indices of neighborhood disadvantage with emergency medical services (EMS) interventions in children.

Methods: We performed a retrospective study of EMS encounters for children (<18 years) from approximately 2000 US EMS agencies between 2021 and 2022. Our exposures were the Child Opportunity Index (COI; v2.0), 2021 Area Deprivation Index (ADI), and 2018 Social Vulnerability Index (SVI). We evaluated the agreement in how children were classified with each index using the intraclass correlation coefficient. We used logistic regression to evaluate the association of each index with transport status, presence of cardiac arrest, and condition-specific interventions and assessments.

Results: We included 738,892 encounters. The correlation between the indices indicated good agreement (intraclass correlation coefficient=0.75). There was overlap in relationships between the COI, ADI, and SVI for each of the study outcomes, both when visualized as a splined predictor and when using representative odds ratios (OR) comparing the third quartile of each index to the lower quartile (most disadvantaged). For example, the OR of non-transport was 1.12 (95% confidence interval [CI]: 1.10-1.14) for COI, 1.18 (95% CI: 1.16-1.20) for ADI, and 1.22 (95% CI: 1.20-1.23) for SVI.

Conclusion: The COI, ADI, and SVI had good correlation and demonstrated similar effect size estimates for a variety of clinical outcomes. While investigators should consider potential causal pathways for outcomes when selecting an index for neighborhood disadvantage, the relative strength of association between each index and all outcomes was similar.

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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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