美国初级保健医生的密度与死亡率。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2024-10-01 DOI:10.1016/j.jnma.2024.10.001

Ali Bin Abdul Jabbar , Khawaja M Talha , Vijay Nambi , Dmitry Abramov , Abdul Mannan Khan Minhas

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引用次数: 0

摘要

背景：地理上的医生可用性差异与医疗保健结果有关。然而，初级保健医生（PCP）密度与死亡率结果之间的关联却不那么明确：该研究分析了卫生资源与服务管理局地区卫生资源档案中的 2019 年县级非联邦初级保健医生数据，以及使用疾病预防控制中心 WONDER（用于流行病学研究的广泛在线数据）的死亡率数据。根据每十万人中初级保健医生数量的四分位数，提取了每十万人中与全因和心血管疾病（CVD）相关的年龄调整死亡率（AAMR）。将年龄调整死亡率作为连续变量，进行线性回归，以确定年龄调整死亡率与每十万人初级保健医生数（参考值，第一四分位数）之间的关系，并对社会脆弱性指数（SVI）进行调整：共有 3142 个县被纳入分析。在按每 10 万名初级保健医生四分位数分层的县中，全因急性心肌梗死死亡率在第一四分位数为 828（95% CI，824-832），第二四分位数为 798（95% CI，796-801），第三四分位数为 737（95% CI，735-739），第四四分位数为 679（95% CI，678-680）。与心血管疾病相关的 AAMRs 也呈现类似趋势，分别为 446（95% CI，443-449）、439（95% CI，437-441）、403（95% CI，402-404）和 365（95% CI，364-366）。没有五氯苯酚的县（221 个，包括在第一四分位数中）的全因和心血管疾病相关 AAMR 分别为 797（95%CI，783-812）和 430（95%CI，419-440）。与第一四分位数相比，SVI 调整分析显示，第二、第三和第四四分位数的全因死亡率 β 系数（95%CI）分别为-4.11（95% CI，-18.31，10.08）、-35.37（95% CI，-49.57，-21.17）和-85.79（95% CI，-100.10，-71.48）。心血管疾病相关的 AAMR 也观察到类似的结果：每 10 万人中较高的 PCP 一般与较好的全因死亡率和心血管疾病相关死亡率结果相关，但在每 10 万人中较低 PCP 的县中，决定这些结果的因素可能很复杂，值得进一步研究。

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Primary care physician density and mortality in the United States

Background

Geographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established.

Methods

The study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI).

Results

A total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824–832) in the first quartile, 798 (95% CI, 796–801) in the second quartile, 737 (95% CI, 735–739) in the third quartile, and 679 (95% CI, 678–680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443–449), 439 (95% CI, 437–441), 403 (95% CI, 402–404), and 365 (95% CI, 364–366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783–812) and 430 (95%CI, 419–440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of −4.11 (95% CI, −18.31, 10.08), −35.37 (95% CI, −49.57, −21.17) and −85.79 (95% CI, −100.10, −71.48). Similar results were observed for CVD-related AAMR.

Conclusion

Higher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.