加拿大安大略省及时接受择期手术的社会决定因素:一项横断面人群研究。

CMAJ open Pub Date : 2023-12-19 Print Date: 2023-11-01 DOI:10.9778/cmajo.20230001
Pieter de Jager, Dionne Aleman, Nancy Baxter, Chaim Bell, Merve Bodur, Andrew Calzavara, Robert Campbell, Michael Carter, Scott Emerson, Anna Gagliardi, Jonathan Irish, Danielle Martin, Samantha Lee, Marcy Saxe-Braithwaite, Pardis Seyedi, Julie Takata, Suting Yang, Claudia Zanchetta, David Urbach
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引用次数: 0

摘要

背景:公平地获得外科医疗服务对临床和政策都有影响。我们评估了安大略省社会不利条件与择期外科手术等待时间之间的关系:我们使用行政数据集对 2013 年 4 月至 2019 年 12 月期间接受非急诊腹股沟疝修补术、胆囊切除术、髋关节置换术、膝关节置换术、关节镜手术、良性子宫手术和白内障手术的成人进行了横截面分析。我们采用广义估计方程逻辑回归法评估了超出目标等待时间与边缘化维度最高与最低五分位数之间的关系:在纳入的 1 385 673 例手术中,174 633 例(12.6%)超过了目标等待时间。对白内障手术进行调整分析后发现,居住地不稳定(调整后奇数比 [OR] 1.16,95% 置信区间 [CI]1.11-1.21)和近期移民(调整后 OR 1.12,95% 置信区间 1.07-1.18)的患者超过等待时间的几率明显增加。最贫困的五分之一人口的膝关节和髋关节置换术等待时间超过标准的几率分别增加了18%(调整后OR值为1.18,95% CI为1.12-1.24)和20%(调整后OR值为1.20,95% CI为1.12-1.28)。居住在自认为属于明显少数群体的居民比例较高的地区与髋关节置换术(调整后OR值为0.82,95% CI为0.75-0.91)、胆囊切除术(调整后OR值为0.68,95% CI为0.59-0.79)和疝气修补术(调整后OR值为0.65,95% CI为0.56-0.77)超过目标等待时间的几率降低独立相关,而良性子宫手术(调整后OR值为1.28,95% CI为1.17-1.40)则与之相反:社会不利条件对在目标等待时间内接受治疗的影响较小且不一致。未来的研究应考虑这些差异与资源分配和临床服务提供组织的关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Social determinants of access to timely elective surgery in Ontario, Canada: a cross-sectional population level study.

Background: Equitable access to surgical care has clinical and policy implications. We assess the association between social disadvantage and wait times for elective surgical procedures in Ontario.

Methods: We conducted a cross-sectional analysis using administrative data sets of adults receiving nonurgent inguinal hernia repair, cholecystectomy, hip arthroplasty, knee arthroplasty, arthroscopy, benign uterine surgery and cataract surgery from April 2013 to December 2019. We assessed the relation between exceeding target wait times and the highest versus lowest quintile of marginalization dimensions by use of generalized estimating equations logistic regression.

Results: Of the 1 385 673 procedures included, 174 633 (12.6%) exceeded the target wait time. Adjusted analysis for cataract surgery found significantly increased odds of exceeding wait times for residential instability (adjusted odd ratio [OR] 1.16, 95% confidence interval [CI] 1.11-1.21) and recent immigration (adjusted OR 1.12, 95% CI 1.07-1.18). The highest deprivation quintile was associated with 18% (adjusted OR 1.18, 95% CI 1.12-1.24) and 20% (adjusted OR 1.20, 95% CI 1.12-1.28) increased odds of exceeding wait times for knee and hip arthroplasty, respectively. Residence in areas where higher proportions of residents self-identify as being part of a visible minority group was independently associated with reduced odds of exceeding target wait times for hip arthroplasty (adjusted OR 0.82, 95% CI 0.75-0.91), cholecystectomy (adjusted OR 0.68, 95% CI 0.59-0.79) and hernia repair (adjusted OR 0.65, 95% CI 0.56-0.77) with an opposite effect in benign uterine surgery (adjusted OR 1.28, 95% CI 1.17-1.40).

Interpretation: Social disadvantage had a small and inconsistent impact on receiving care within wait time targets. Future research should consider these differences as they relate to resource distribution and the organization of clinical service delivery.

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