Assessment of Tuberculosis Infection-Related Outpatient Clinical Outcomes Across Neighborhood-Level Deprivation Quartiles.

IF 2.5 4区 医学 Q3 INFECTIOUS DISEASES
Melissa E Day, Qing Duan, Mary Carol Burkhardt, Melissa Klein, Elizabeth P Schlaudecker, Andrew F Beck
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引用次数: 0

Abstract

Background: Pediatric tuberculosis infection (TBI) disproportionately affects those in complex social situations. Neighborhood characteristics may influence access to care and TBI-related outcomes. We sought to examine links between neighborhood-level socioeconomic deprivation and clinical outcomes.

Methods: In this retrospective cohort study, we identified children with TBI treated at our pediatric infectious diseases clinics between 2012 and 2023. We geocoded each child's address to identify neighborhood-level material community deprivation index (MCDI) scores. Outcomes included missed clinic visits, missed antibiotic doses, and changes in antibiotic therapy due to adherence concerns. We assessed the time between referral and first visit, first and second visits, and first and last visits. Kruskal-Wallis rank sum test and chi-squared tests examined relationships between DI quartile and clinical outcomes. Log-rank testing and Cox proportional hazard regression models evaluated time-to-event analyses.

Results: We identified 150 children with TBI. There were no differences across MCDI quartiles in rates of missed clinic visits, missed antibiotic doses, changed therapy, or therapy completion. Higher deprivation was associated with a longer time between referral and first visit (median 12 days for low/moderate-low deprivation quartiles vs. 24 days for high/moderate-high deprivation quartiles, P = .004). The high/moderate-high deprivation category had a 39% lower hazard of getting to the first clinic visit after referral compared to the low/moderate-low deprivation category (HR 0.61; 95% CI, .43, .85) after adjustment for race, insurance, and language.

Conclusions: Children with TBI from socioeconomically deprived neighborhoods have longer times from referral to first clinical evaluation. Exploring drivers of differences could promote more equitable TBI care.

社区水平剥夺四分位数结核病感染相关门诊临床结果评估
背景:儿童结核感染(TBI)不成比例地影响那些复杂的社会环境。社区特征可能影响获得护理和创伤性脑损伤相关结果。我们试图研究社区水平的社会经济剥夺和临床结果之间的联系。方法:在这项回顾性队列研究中,我们确定了2012-2023年在我们的儿科传染病诊所治疗的TBI儿童。我们对每个孩子的地址进行地理编码,以确定邻里水平的物质社区剥夺指数(MCDI)得分。结果包括错过门诊就诊,错过抗生素剂量,以及由于依从性问题而改变抗生素治疗。我们评估了转诊和第一次就诊、第一次和第二次就诊以及第一次和最后一次就诊之间的时间。Kruskal-Wallis秩和检验和卡方检验检验了DI四分位数与临床结果之间的关系。Log-rank检验和Cox比例风险回归模型评估了时间-事件分析。结果:我们确定了150例TBI患儿。MCDI四分位数在错过门诊就诊、错过抗生素剂量、改变治疗或治疗完成率方面没有差异。较高的剥夺程度与转诊和首次就诊之间的时间间隔较长相关(低/中-低剥夺四分位数的中位数为12天,而高/中-高剥夺四分位数的中位数为24天,p=0.004)。与低/中-低剥夺类别相比,高/中-高剥夺类别转诊后第一次就诊的风险低39% (HR 0.61;95%CI 0.43, 0.85),校正种族、保险和语言。结论:来自社会经济贫困社区的TBI儿童从转诊到首次临床评估的时间较长。探索差异的驱动因素可以促进更公平的创伤性脑损伤治疗。
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来源期刊
Journal of the Pediatric Infectious Diseases Society
Journal of the Pediatric Infectious Diseases Society Medicine-Pediatrics, Perinatology and Child Health
CiteScore
6.70
自引率
0.00%
发文量
179
期刊介绍: The Journal of the Pediatric Infectious Diseases Society (JPIDS), the official journal of the Pediatric Infectious Diseases Society, is dedicated to perinatal, childhood, and adolescent infectious diseases. The journal is a high-quality source of original research articles, clinical trial reports, guidelines, and topical reviews, with particular attention to the interests and needs of the global pediatric infectious diseases communities.
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