Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study.

Lourdes Artajona, Ana García-Martínez, Sira Aguiló, Guillermo Burillo-Putze, Aitor Alquézar-Arbé, Cesáreo Fernández, Amparo Fernández-Simón, María Fernández Cardona, María Teresa Maza Vera, Marta Iglesias Vela, Patricia Trenc Español, Manuel Salido Mota, Ángel García García, Carmen Lucena Aguilera, Ferran Llopis, Pablo Herrero, Adriana Laura Doi Grande, Leticia Serrano Lázaro, Ana Chacon García, José J Noceda Bermejo, Amanda Ibisate Cubillas, María José Hernández Martínez, Francesc Xavier Alemany González, Susana Sánchez Ramón, Begoña Espinosa Fernández, Juan González Del Castillo, Òscar Miró
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引用次数: 0

Abstract

Objectives: To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments.

Material and methods: Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions.

Results: Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667).

Conclusion: The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.

COVID-19 大流行第一波期间收入对老年人院内死亡率的影响:EDEN-33 研究的结果。
目的确定在西班牙公共卫生系统医院急诊科接受治疗的老年患者的收入是否与院内意外死亡率有关:西班牙 51 家公共卫生系统医院急诊科自愿参与了这项研究。在大流行前的一周(2019 年 4 月 1 日至 7 日)和 COVID-19 大流行期间的一周(2020 年 3 月 30 日至 4 月 5 日),这些医院共覆盖了所有患者登记册中 65 岁或以上人口的 25%。我们根据患者地址邮政编码公布的金额来估算患者的总收入。然后,我们用患者的估计收入除以相应地区(西班牙自治区)的平均值,计算出标准化总收入(SGI)。根据基线时患者的 10 项特征,通过限制性立方样条曲线 (RCS) 对 SGI 与住院死亡率之间是否存在关联以及关联的强度进行了评估。每个收入水平的比值比(ORs)都与参考 SGI 1(相应自治区的平均收入)相关。我们通过一阶交互作用比较了 COVID-19 和大流行前的情况:在两个时期就诊的 35 280 名患者中,有 21 180 人(60%)的总收入可以确定,其中大流行前有 15437 人,COVID-19 期间有 5746 人。大流行前纳入的患者的 SGI 略高(1.006 vs 0.994;P = .012)。总体院内死亡率为 5.6%,大流行期间更高(大流行前为 2.8% vs COVID-19 期间为 13.1%;P .001)。调整后的 RCS 曲线显示,收入与死亡率之间的关系在两个时期有所不同(交互作用 P = .004)。在大流行之前,死亡率没有明显的收入影响差异,但在大流行期间,最低收入人群(SGI 0.5 OR,1.82;95% CI,1.32-3.37)和较高收入人群(SGI 1.5 OR,1.32;95% CI,1.04-1.68 和 SGI 2 OR,1.92;95% CI,1.14-3.23)的死亡率有所上升。我们发现 COVID-19 患者与其他诊断的患者之间没有明显差异(交互作用 P = .667):结论:根据患者地址和邮政编码估算的西班牙公共卫生系统医院急诊科就诊患者的总收入与院内死亡率有关,收入水平最低的患者和收入水平较高的患者的院内死亡率较高。造成这些关联的原因可能因收入水平而异,今后应对此进行研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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