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美国住房券和后续就医与支出之间的相关性
作者:小柯机器人 发布时间:2019/12/9 11:16:05

美国波士顿医疗中心Alastair Bell团队的一项最新研究分析了住房券和后续就医与支出之间的相关性。相关论文于2019年12月3日发表于国际顶尖学术期刊《美国医学会杂志》上。

尽管社区被认为是决定健康的一个重要因素,但社区贫困与就医间的关系仍不甚明了,因为之前的研究大多采用观察数据,而非实验设计。

1994-1998年,研究组在美国的5个城市进行了一项随机社会实验,将4604个公共住房家庭随机分为3组:对照组、传统住房券组和只能用于低贫困社区的住房券组。

中位随访11年后,在4602名符合条件的成人中,4072名(88.5%)与健康数据相关。与对照组相比,接受住房券的成人未校正住院率为14.0/100人年,住院天数为62.8天/100人年,年支出为2075美元,而对照组则分别为14.7/100人年、67.0天/100人年和1977美元,均无显著性差异。

而在11290名符合条件的儿童中,9118名(80.8%)与健康数据相关。童年获得住房券的参与者住院率为6.3/100人年,每年住院费用为633美元,均显著低于对照组(7.3/100人年和785美元);住院天数为25.7天/100人年,对照组为28.8天/100人年,差异不显著。

总之,在这项住房券干预的探索性分析中,接受住房券的成年人在就医或费用支出方面无显著差异,但接受住房券的儿童住院率较低,费用支出较少。

附:英文原文

Title: Association of Receipt of a Housing Voucher With Subsequent Hospital Utilization and Spending

Author: Craig Evan Pollack, Amanda L. Blackford, Shawn Du, Stefanie Deluca, Rachel L. J. Thornton, Bradley Herring

Issue&Volume: 2019/12/03

Abstract:

Importance  Although neighborhoods are thought to be an important health determinant, evidence for the relationship between neighborhood poverty and health care use is limited, as prior studies have largely used observational data without an experimental design.

Objective  To examine whether housing policies that reduce exposure to high-poverty neighborhoods were associated with differences in long-term hospital use among adults and children.

Design, Setting, and Participants  Exploratory analysis of the Moving to Opportunity for Fair Housing Demonstration Program, a randomized social experiment conducted in 5 US cities. From 1994 to 1998, 4604 families in public housing were randomized to 1 of 3 groups: a control condition, a traditional Section 8 voucher toward rental costs in the private market, or a voucher that could only be used in low-poverty neighborhoods. Participants were linked to all-payer hospital discharge data (1995 through 2014 or 2015) and Medicaid data (1999 through 2009). The final follow-up date ranged from 11 to 21 years after randomization.

Exposures  Receipt of a traditional or low-poverty voucher vs control group.

Main Outcomes and Measures  Rates of hospitalizations and hospital days, and hospital spending.

Results  Among 4602 eligible individuals randomized as adults, 4072 (88.5%) were linked to health data (mean age, 33 years [SD, 9.0 years]; 98% female; median follow-up, 11 years). There were no significant differences in primary outcomes among adults randomized to receive a voucher compared with the control group (unadjusted hospitalization rate, 14.0 vs 14.7 per 100 person-years, adjusted incidence rate ratio [IRR], 0.95 [95% CI, 0.84-1.08; P = .45]; hospital days, 62.8 vs 67.0 per 100 person-years; IRR, 0.93 [95% CI, 0.77-1.13; P = .46]; yearly spending, $2075 vs $1977; adjusted difference, −$129 [95% CI, −$497 to $239; P = .49]). Among 11?290 eligible individuals randomized as children, 9118 (80.8%) were linked to health data (mean age, 8 years [SD, 4.6 years]; 49% female; median follow-up, 11 years). Receipt of a housing voucher during childhood was significantly associated with lower hospitalization rates (6.3 vs 7.3 per 100 person-years; IRR, 0.85 [95% CI, 0.73-0.99; P = .03]) and yearly inpatient spending ($633 vs $785; adjusted difference, −$143 [95% CI, −$256 to −$31; P = .01]) and no significant difference in hospital days (25.7 vs 28.8 per 100 person-years; IRR, 0.92 [95% CI, 0.77-1.11; P = .41]).

Conclusions and Relevance  In this exploratory analysis of a randomized housing voucher intervention, adults who received a housing voucher did not experience significant differences in hospital use or spending. Receipt of a voucher during childhood was significantly associated with lower rates of hospitalization and less inpatient spending during long-term follow-up.

DOI: 10.1001/jama.2019.17432

Source: https://jamanetwork.com/journals/jama/article-abstract/2756289

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex