Beau Blass BS , Jay B. Lusk MD, MBA , Hannah Mahoney MS , Molly N. Hoffman MPH , Amy G. Clark PhD , Jonathan Bae MD , Matthew J. Townsend MD, MSc, MPP , Amit Patel MD , Andrew J. Muir MD, MHS , Bradley G. Hammill DrPH
{"title":"社区社会经济剥夺与常见胃肠道疾病入院后30天的结果：一项大型全国性研究","authors":"Beau Blass BS , Jay B. Lusk MD, MBA , Hannah Mahoney MS , Molly N. Hoffman MPH , Amy G. Clark PhD , Jonathan Bae MD , Matthew J. Townsend MD, MSc, MPP , Amit Patel MD , Andrew J. Muir MD, MHS , Bradley G. Hammill DrPH","doi":"10.1016/j.gastha.2025.100614","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to healthcare resources, and treatment facility characteristics.</div></div><div><h3>Methods</h3><div>We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017-2019 for common gastrointestinal diseases, grouped by Diagnosis Related Groups (DRGs). We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index (ADI), with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multi-step adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient healthcare resources, and hospital-level characteristics.</div></div><div><h3>Results</h3><div>In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully-adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for non-malignant pancreatic disorders (OR 1.59, 95% CI 1.25-2.01), esophageal disorders (OR 1.50, 95% 1.02-2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29-1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16-1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.</div></div><div><h3>Conclusion</h3><div>We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to healthcare resources, and characteristics of treating facilities.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 5","pages":"Article 100614"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neighborhood Socioeconomic Deprivation and 30-Day Outcomes After Admission for Common Gastrointestinal Conditions: A Large Nationwide Study\",\"authors\":\"Beau Blass BS , Jay B. Lusk MD, MBA , Hannah Mahoney MS , Molly N. Hoffman MPH , Amy G. Clark PhD , Jonathan Bae MD , Matthew J. Townsend MD, MSc, MPP , Amit Patel MD , Andrew J. Muir MD, MHS , Bradley G. Hammill DrPH\",\"doi\":\"10.1016/j.gastha.2025.100614\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and Aims</h3><div>To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to healthcare resources, and treatment facility characteristics.</div></div><div><h3>Methods</h3><div>We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017-2019 for common gastrointestinal diseases, grouped by Diagnosis Related Groups (DRGs). We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index (ADI), with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multi-step adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient healthcare resources, and hospital-level characteristics.</div></div><div><h3>Results</h3><div>In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully-adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for non-malignant pancreatic disorders (OR 1.59, 95% CI 1.25-2.01), esophageal disorders (OR 1.50, 95% 1.02-2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29-1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16-1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.</div></div><div><h3>Conclusion</h3><div>We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to healthcare resources, and characteristics of treating facilities.</div></div>\",\"PeriodicalId\":73130,\"journal\":{\"name\":\"Gastro hep advances\",\"volume\":\"4 5\",\"pages\":\"Article 100614\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gastro hep advances\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772572325000019\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastro hep advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772572325000019","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的研究社区社会经济劣势与30天死亡率和常见胃肠道疾病再入院的关系，调整个体人口统计学、合并症、卫生保健资源可及性和治疗机构特征。方法我们分析了2017-2019年因常见胃肠道疾病住院的美国医疗保险受益人的全国样本，按诊断相关组（DRGs）分组。然后，我们利用限制三次样条的逻辑回归模型估计了用区域剥夺指数（ADI）衡量的社区社会经济劣势与30天死亡率和再入院率的关系。我们对个体社会经济地位和人口统计学、医疗合并症、获得住院和门诊医疗资源以及医院水平的特征进行了多步调整。结果共纳入死亡组1,293,483例，再入院组1,289,106例。完全调整的模型显示，社区剥夺与常见胃肠道疾病患者30天死亡率之间存在关联，在最贫困的人群中，非恶性胰腺疾病（OR 1.59, 95% CI 1.25-2.01）、食道疾病（OR 1.50, 95% 1.02-2.21）、胃肠道出血（OR 1.40, 95% CI 1.29-1.52）和胆道疾病（OR 1.40, 95% CI 1.16-1.69）的相关性最强。邻里剥夺与完全适应后30天再入院无关。结论：我们描述了社区剥夺与常见胃肠道疾病患者30天死亡率之间的独立关联，即使在控制了个人贫困、人口统计学和合并症、医疗资源可及性和治疗设施特征之后，这种关联仍然存在。
Neighborhood Socioeconomic Deprivation and 30-Day Outcomes After Admission for Common Gastrointestinal Conditions: A Large Nationwide Study
Background and Aims
To study the associations of neighborhood socioeconomic disadvantage with 30-day mortality and readmission for common gastrointestinal conditions, adjusting for individual demographics, comorbidities, access to healthcare resources, and treatment facility characteristics.
Methods
We analyzed a nationwide sample of United States Medicare beneficiaries hospitalized from 2017-2019 for common gastrointestinal diseases, grouped by Diagnosis Related Groups (DRGs). We then estimated the association of neighborhood socioeconomic disadvantage, measured by the Area Deprivation Index (ADI), with 30-day mortality and readmission utilizing logistic regression models with restricted cubic splines. We performed multi-step adjustments for individual socioeconomic status and demographics, medical comorbidities, access to inpatient and outpatient healthcare resources, and hospital-level characteristics.
Results
In total, 1,293,483 patients in the mortality cohort and 1,289,106 patients in the readmission cohort were included in analysis. The fully-adjusted model demonstrated an association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, with the strongest associations for non-malignant pancreatic disorders (OR 1.59, 95% CI 1.25-2.01), esophageal disorders (OR 1.50, 95% 1.02-2.21), gastrointestinal hemorrhage (OR 1.40, 95% CI 1.29-1.52), and biliary tract disorders (OR 1.40, 95% CI 1.16-1.69) in the most deprived groups. Neighborhood deprivation was not associated with 30-day readmission after full adjustment.
Conclusion
We describe an independent association between neighborhood deprivation and 30-day mortality for patients with common gastrointestinal diseases, which remains even after controlling for individual poverty, demographics and comorbidities, access to healthcare resources, and characteristics of treating facilities.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
