背景:了解邻里环境与心血管结局之间的关系对于实现健康公平和实施有效的质量策略很重要。我们进行了一项基于人群的队列研究,以确定社区社会经济剥夺与常见心血管疾病患者30天死亡率和再入院率之间的关系。
结果:我们检查了2017年至2019年因心力衰竭入院的65岁以上的按服务付费医疗保险受益人的索赔数据。心脏瓣膜病,缺血性心脏病,或者心律失常.主要暴露是区域剥夺指数;结果是30天全因死亡和计划外再入院。包括200多万人。在对患者特征进行顺序调整后(人口统计,双重资格,合并症),地区卫生保健资源(初级保健临床医生,专家,和人均病床),并承认医院的特点(所有权,尺寸,教学状况),在所有情况下,邻里社会经济匮乏与30日死亡率之间存在剂量依赖性关联.在完全调整的死亡模型中,在最弱势和最弱势社区中,估计的居住效应大小从心力衰竭组的调整比值比1.29(95%CI,1.22-1.36)到瓣膜性心脏病组的调整比值比1.63(95%CI,1.36-1.95)不等.邻里剥夺与调整后的30天再入院率增加有关,从心力衰竭的校正比值比1.09(95%CI,1.05-1.14)到心律失常的校正比值比1.19(95%CI,1.13-1.26)的估计效应大小。
结论:社区社会经济劣势与普通心血管疾病患者的30天死亡率和再入院率相关,与个体人口统计学无关。社会经济地位,医疗风险,护理接入,或者承认医院的特点。
BACKGROUND: Understanding the relationship between neighborhood environment and cardiovascular outcomes is important to achieve health equity and implement effective quality strategies. We conducted a population-based cohort study to determine the association of neighborhood socioeconomic deprivation and 30-day mortality and readmission rate for patients admitted with common cardiovascular conditions.
RESULTS: We examined claims data from fee-for-service Medicare beneficiaries aged ≥65 years between 2017 and 2019 admitted for heart failure, valvular heart disease, ischemic heart disease, or cardiac arrhythmias. The primary exposure was the Area Deprivation Index; outcomes were 30-day all-cause death and unplanned readmission. More than 2 million admissions were included. After sequential adjustment for patient characteristics (demographics, dual eligibility, comorbidities), area health care resources (primary care clinicians, specialists, and hospital beds per capita), and admitting hospital characteristics (ownership, size, teaching status), there was a dose-dependent association between neighborhood socioeconomic deprivation and 30-day mortality rate for all conditions. In the fully adjusted model for death, estimated effect sizes of residence in the most disadvantaged versus least disadvantaged neighborhoods ranged from adjusted odds ratio 1.29 (95% CI, 1.22-1.36) for the heart failure group to adjusted odds ratio 1.63 (95% CI, 1.36-1.95) for the valvular heart disease group. Neighborhood deprivation was associated with increased adjusted 30-day readmission rates, with estimated effect sizes from adjusted odds ratio 1.09 (95% CI, 1.05-1.14) for heart failure to adjusted odds ratio 1.19 (95% CI, 1.13-1.26) for arrhythmia.
CONCLUSIONS: Neighborhood socioeconomic disadvantage was associated with 30-day mortality rate and readmission for patients admitted with common cardiovascular conditions independent of individual demographics, socioeconomic status, medical risk, care access, or admitting hospital characteristics.