弗吉尼亚州中部和西部地区贫困指数与痴呆症基础检查和诊断的关系:一项横断面研究

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2024-10-01 Epub Date: 2024-06-10 DOI:10.1212/CPJ.0000000000200323
Anelyssa D'Abreu, Azziza Bankole, Jaideep Kapur, Carol A Manning, Pavel Chernyavskiy
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引用次数: 0

摘要

背景和目标:地区贫困指数(ADI)是一种经过验证的多维度地区贫困指标。我们的目标是确定 ADI 是否会影响弗吉尼亚州中部和西部地区根据已发布的指南和痴呆病因诊断接受检查的可能性:我们从弗吉尼亚大学(UVA)医疗中心(2016-2021年)和Carillion诊所(2018-2021年)诊断出患有痴呆症的50-105岁患者的电子健康记录中收集了去身份化数据。使用特定就诊的 ICD-10 编码将每项痴呆诊断分为 "特定疾病"(如阿尔茨海默病)或 "一般疾病"(如未指定的痴呆)。根据美国神经病学学会的指导方针,如果患者在初次诊断后 6 个月内进行了维生素 B12、促甲状腺激素和脑 CT 或磁共振成像检查,我们则认为所进行的评估是 "充分的"。人口普查区 ADI 与研究参与者相关联,使用的是根据参与者诊断时家庭住址得出的唯一人口普查区标识符。统计建模采用贝叶斯范式,使用 R 语言的标准代码实现:研究包括 13,431 名在弗吉尼亚大学(n = 7,152 人)和 Carillion 诊所(n = 6,279 人)确诊为痴呆症的患者。其中,32.5%和20.4%的患者在UVA和Carillion诊所接受了 "特定疾病 "诊断,8.2%和20.4%的患者接受了 "充分 "检查。人口普查区 ADI 与疾病特异性诊断可能性之间的调整关系呈 U 型:居住在中度贫困地区的患者获得疾病特异性诊断的可能性最低:讨论:大多数被诊断为痴呆症的患者没有得到充分的评估或病因诊断。那些居住在略高于全国平均每日生活费中位数水平的地区的患者得到病因诊断的可能性最低,低于那些居住在最贫困和最贫困地区的患者。需要提高医疗服务提供者的认识,以加强对诊断指南的遵守。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of the Area Deprivation Index With Dementia Basic Workup and Diagnosis in Central and Western Virginia: A Cross-Sectional Study.

Background and objectives: The Area Deprivation Index (ADI) provides a validated and multidimensional metric of areal disadvantage. Our goals were to determine if the ADI influences the likelihood of receiving workup based on published guidelines and an etiologic diagnosis of dementia in Central and Western Virginia.

Methods: We collected deidentified data from the electronic health record of individuals aged 50-105 years diagnosed with dementia at the University of Virginia (UVA) Medical Center (2016-2021) and at Carillion Clinic (2018-2021). Visit-specific ICD-10 codes were used to classify each dementia diagnosis as "disease-specific" (e.g., Alzheimer disease) or "general" (e.g., unspecified dementia). Following the American Academy of Neurology guidelines, we considered the evaluation performed as "adequate" if patients had vitamin B12, thyroid-stimulating hormone, and brain CT or magnetic resonance imaging within 6 months of the initial diagnosis. Census tract ADI was linked to study participants using the unique census tract identifier derived from the participants' home addresses at the time of diagnosis. Statistical modeling occurred under a Bayesian paradigm implemented using a standard code in R.

Results: The study included 13,431 individuals diagnosed with dementia at UVA (n = 7,152) and Carillion Clinic (n = 6,279). Of those, 32.5% and 20.4% received "disease-specific" diagnoses at UVA and Carillion Clinic and 8.2% and 20.4% underwent "adequate" workup, respectively. The adjusted relationship between census tract ADI and the likelihood of a disease-specific diagnosis was U-shaped: Residence in moderately disadvantaged areas was associated with the lowest likelihood of disease-specific diagnosis.

Discussion: Most patients diagnosed with dementia did not receive an adequate evaluation or an etiologic diagnosis. Those living in locations just above the national median ADI levels had the lowest likelihood of receiving an etiologic diagnosis, lower than those in the least and most deprived areas. Renewed awareness efforts among providers are needed to increase compliance with diagnostic guidelines.

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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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