背景:急性健康急性护理中的种族不平等尚未得到很好的研究。我们研究了参与者种族如何影响未选择的胃肠道(GI)疾病患者的急诊治疗结果。
方法:描述性,莱斯特大学医院急诊科参与者匿名患者水平数据的回顾性队列分析,从2018年1月1日至2021年12月31日,我们接受了胃肠道疾病诊断.感兴趣的主要接触是自我报告的种族,研究的两个结局是入院和患者是否接受了临床调查.混杂变量,包括性别和年龄,在分析中调整了剥夺指数和疾病敏锐度.卡方检验和Kruskal-Wallis检验用于检查结果指标和协变量之间的种族差异。多变量逻辑回归用于检查种族和结果测量之间的关联。
结果:在34,337人中,中位年龄43岁,被确定为患有胃肠道疾病的急诊室,68.6%是白人。少数民族患者明显比白人患者年轻。所有种族的多急诊科出勤率相似(总体为18.3%)。白人患者的调查中位数最高(6,IQR3-7),而来自混合族裔的人最低(2,IQR0-6)。调整后的年龄,性别,出席年,多重剥夺和疾病敏锐度指数,与白种人患者相比,所有少数族裔患者接受现症调查的可能性仍然显著较低(亚裔:aOR0.80,95%CI0.74~0.87;黑人:0.67,95%CI0.58~0.79;混合:0.71,95%CI0.59~0.86;其他:0.79,95%CI0.67~0.93;全部p<0.0001).同样,调整后,少数族裔患者入院的可能性也明显较小(亚裔:aOR0.63,95%CI0.60-0.67;黑人:0.60,95%CI0.54-0.68;混合:0.60,95%CI0.51-0.71;其他:0.61,95%CI0.54-0.69;全部p<0.0001).
结论:本研究观察到不同种族胃肠道疾病患者在使用模式和急性护理结果方面的显著差异。在对混杂因素以及剥夺和疾病敏锐度的测量进行调整后,这些差异仍然存在,并且表明与白人患者相比,少数民族个体不太可能接受调查或入院。
BACKGROUND: Ethnic inequalities in acute health acute care are not well researched. We examined how attendee ethnicity influenced outcomes of emergency care in unselected patients presenting with a gastrointestinal (GI) disorder.
METHODS: A descriptive, retrospective cohort analysis of anonymised patient level data for University Hospitals of Leicester emergency department attendees, from 1 January 2018 to 31 December 2021, receiving a diagnosis of a GI disorder was performed. The primary exposure of interest was self-reported ethnicity, and the two outcomes studied were admission to hospital and whether patients underwent clinical investigations. Confounding variables including sex and age, deprivation index and illness acuity were adjusted for in the analysis. Chi-squared and Kruskal-Wallis tests were used to examine ethnic differences across outcome measures and covariates. Multivariable logistic regression was used to examine associations between ethnicity and outcome measures.
RESULTS: Of 34,337 individuals, median age 43 years, identified as attending the ED with a GI disorder, 68.6% were White. Minority ethnic patients were significantly younger than White patients. Multiple emergency department attendance rates were similar for all ethnicities (overall 18.3%). White patients had the highest median number of investigations (6, IQR 3-7), whereas those from mixed ethnic groups had the lowest (2, IQR 0-6). After adjustment for age, sex, year of attendance, index of multiple deprivation and illness acuity, all ethnic minority groups remained significantly less likely to be investigated for their presenting illness compared to White patients (Asian: aOR 0.80, 95% CI 0.74-0.87; Black: 0.67, 95% CI 0.58-0.79; mixed: 0.71, 95% CI 0.59-0.86; other: 0.79, 95% CI 0.67-0.93; p < 0.0001 for all). Similarly, after adjustment, minority ethnic attendees were also significantly less likely to be admitted to hospital (Asian: aOR 0.63, 95% CI 0.60-0.67; Black: 0.60, 95% CI 0.54-0.68; mixed: 0.60, 95% CI 0.51-0.71; other: 0.61, 95% CI 0.54-0.69; p < 0.0001 for all).
CONCLUSIONS: Significant differences in usage patterns and disparities in acute care outcomes for patients of different ethnicities with GI disorders were observed in this study. These differences persisted after adjustment both for confounders and for measures of deprivation and illness acuity and indicate that minority ethnic individuals are less likely to be investigated or admitted to hospital than White patients.