利用基于区域的措施检测弱势群体低健康素养的风险。

Andrew J Knighton, Kimberly D Brunisholz, Samuel T Savitz
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引用次数: 24

摘要

社会经济地位(SES)与低健康素养(LHL)密切相关。两者都与临床和行为风险因素以及医疗保健结果直接相关。学习型医疗保健系统正在引入小范围措施,以解决与维持患者报告的SES和LHL措施相关的挑战。本研究的目的是测量与SES和LHL相关的两个可用的人口普查块测量之间的关联。理解这种关系可以指导确定基于交付系统使用的多用途区域的度量。方法:采用回顾性观察设计,使用犹他州所有美国人口普查街区组。主要因变量为国家标准化健康素养评分(HLS)。主要解释变量为国家标准化面积剥夺指数(ADI)。统计方法包括线性回归和关联检验。受试者工作特征(ROC)分析采用ADI制定LHL标准。结果:在调整区域水平的危险因素后,HLS和ADI评分之间仍然存在显著的负相关(β: -0.21 (95% CI: -0.22, -0.19) p < 0.001)。结论:HLS和ADI使用不同的测量标准,但密切相关。与使用全国HLS相比,以州为基础的ADI检测到更多有LHL风险的社区。ADI代表了一种多用途的社会决定因素区域测量,有助于学习卫生系统量身定制护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures.

Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures.

Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures.

Introduction: Socio-economic status (SES) and low health literacy (LHL) are closely correlated. Both are directly associated with clinical and behavioral risk factors and healthcare outcomes. Learning healthcare systems are introducing small-area measures to address the challenges associated with maintaining patient-reported measures of SES and LHL. This study's purpose was to measure the association between two available census block measures associated with SES and LHL. Understanding the relationship can guide the identification of a multi-purpose area based measure for delivery system use.

Methods: A retrospective observational design was deployed using all US Census block groups in Utah. The principal dependent variable was a nationally-standardized health literacy score (HLS). The primary explanatory variable was a state-standardized area deprivation index (ADI). Statistical methods included linear regression and tests of association. Receiver operating characteristic (ROC) analysis was used to develop LHL criteria using ADI.

Results: A significant negative association between the HLS and the ADI score remained after adjusting for area-level risk factors (β: -0.21 (95% CI: -0.22, -0.19) p < .001). Eighteen block groups (<1%) were identified as having LHL using HLS. A combination of three or more ADI components correlated with LHL predicted 78% of HLS LHL block groups and 35 additional block groups not identified using HLS (c-statistic: 0.64; 95% CI: 0.62, 0.66).

Conclusions: HLS and ADI use differing measurement criteria but are closely correlated. A state-based ADI detected additional neighborhoods with risk of LHL compared to use of a national HLS. An ADI represents a multi-purpose area measure of social determinants useful for learning health systems tailoring care.

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