目的:在COVID-19大流行的第二年,研究司法参与状况对非老年人院内死亡率的影响。
方法:这项回顾性队列研究使用了来自美国20个州的2021个州住院数据库(SID)的数据,其中包括住院至少24小时的18-64岁成年人从普通急性护理医院出院.主要结果是全因住院死亡率,主要比较是司法参与状况。我们使用逻辑回归估计优势比(OR)和95%置信区间(CI),随着社会人口因素的调整,Elixhauser合并症,COVID-19诊断,入院敏锐度,其他临床特征,大都市区和季节性。我们将数据随机分成50%的训练和50%的验证集。对于后者,我们评估了我们最终模型的性能。
结果:研究人群包括4,712,441例出院(1.1%涉及司法;平均[SD]年龄47.5[12.8]岁;47.0%的女性;63.6%的白人,21.8%黑色,11.8%西班牙裔,1.8%亚洲/太平洋岛民[API],和1.0%美洲印第安人/阿拉斯加原住民[AIAN])。其中,发生102,735例住院死亡(2.2%)。在多变量分析中,在涉及司法的患者中,院内死亡率降低约40%(OR0.6,95%CI0.5~0.7,P值<0.01).最终验证的模型显示出出色的区分(受试者操作员特征0.953,95CI0.952至0.954的曲线下面积[AUC])和良好的校准(Brier评分0.014,校准带P值0.186)。
结论:在这项队列研究中,司法参与状态与较低的住院死亡率独立相关.未来的研究应该检查入院前和出院后的结果。
OBJECTIVE: The purpose of this research is to examine the role of justice-involved status on in-hospital mortality among nonelderly adults during the second year of the COVID-19 pandemic.
METHODS: This retrospective cohort study used data from the 2021 State Inpatient Databases for 20 US states, which included discharges from general acute care hospitals among adults aged 18-64 years hospitalized for at least 24 hours. The main outcome was all-cause in-hospital mortality and the primary comparison was justice-involved status. We used logistic regression to estimate the odds ratios and 95% confidence intervals (CIs), with adjustment for sociodemographic factors, Elixhauser comorbidities, COVID-19 diagnosis, admission acuity, other clinical features, metropolitan area, and seasonality. We randomly split the data into a 50% training and 50% validation set. With the latter, we evaluated the performance of our final model.
RESULTS: The study population included 4,712,441 discharges (1.1% justice-involved; mean [SD] age 47.5 [12.8] years; 47.0% women; 63.6% White, 21.8% Black, 11.8% Hispanic, 1.8% Asian/Pacific Islander, and 1.0% American Indian/Alaska Native). Among these, 102,735 in-hospital deaths (2.2%) occurred. In the multivariate analysis, in-hospital mortality was about 40% less likely among justice-involved patients (odds ratios 0.6, 95% CI 0.5-0.7, P value <0.01). The final validated model showed excellent discrimination (area under the curve for the receiver operator characteristic 0.953, 95% CI 0.952-0.954) and good calibration (Brier score 0.014, calibration belt P value .186).
CONCLUSIONS: In this cohort study, justice-involved status was independently associated with lower in-hospital mortality. Future studies should examine preadmission and postdischarge outcomes.