Cargando…

The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis

BACKGROUND: The impact of socioeconomic status on health has been established via a broad body of literature, largely from high-income countries. Investigative efforts in low- and middle-income countries have suffered from a lack of reporting standardization required to draw comparisons across count...

Descripción completa

Detalles Bibliográficos
Autores principales: Kannan, Vijay C., Rasamimanana, Giannie N., Novack, Victor, Hassan, Lior, Reynolds, Teri A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795438/
https://www.ncbi.nlm.nih.gov/pubmed/31618277
http://dx.doi.org/10.1371/journal.pone.0223045
_version_ 1783459442662047744
author Kannan, Vijay C.
Rasamimanana, Giannie N.
Novack, Victor
Hassan, Lior
Reynolds, Teri A.
author_facet Kannan, Vijay C.
Rasamimanana, Giannie N.
Novack, Victor
Hassan, Lior
Reynolds, Teri A.
author_sort Kannan, Vijay C.
collection PubMed
description BACKGROUND: The impact of socioeconomic status on health has been established via a broad body of literature, largely from high-income countries. Investigative efforts in low- and middle-income countries have suffered from a lack of reporting standardization required to draw comparisons across countries of varying economic strata. In this study we aimed to evaluate the impact of socioeconomic status on emergency department outcomes in a low-income African country using international data classification systems. METHODS: This was a retrospective cohort study was conducted at a tertiary care center in northern Madagascar. Data were abstracted from paper charts into an electronic registry using Integrated Public Use Microdata Series codes for occupation, Nam-Powers-Boyd (NPB) scores for socioeconomic status, and Clinical Classifications Software ICD-9 equivalents for diagnosis. Outcome was dichotomized to the combined disposition of death or transfer directly to operating theater (OT) versus discharge. We used t-tests to compare baseline characteristics between these groups. We used chi-square analysis to test the association between occupational class and diagnosis. Finally, multivariate logistic regression analysis was performed examining the impact of NPB score on death/OT outcome, adjusting for age, gender, diagnosis and occupation. RESULTS: 5271 patients were seen during the 21-month study period with a death/OT rate of 9.7%. Older age and male gender were more common in death/OT patients (both p<0.001), and were shown to have positive odds ratios for this outcome in multivariate modeling (p<0.006 and <0.001). Occupational class was found to influence diagnosis for all classes (p<0.001) except Sales and Office. Adjusting for these 3 factors, we found a strong independent association between NPB quartile and death/OT outcome. Relative to the 1(st) quartile, the odds ratio in the 4(th) quartile was 2.9 (p = 0.004), the 3(rd) quartile 1.8 (p = 0.094), and the 2(nd) quartile 3.1 (p<0.001). CONCLUSION: To our knowledge, this is the first Malagasy study describing the relationship between socioeconomic status on emergency care outcomes. We found a stronger effect on health in this setting than in high-income countries, highlighting an important healthcare disparity. By using standardized classification systems we hope this study will serve as a model to facilitate future comparative efforts.
format Online
Article
Text
id pubmed-6795438
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-67954382019-10-20 The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis Kannan, Vijay C. Rasamimanana, Giannie N. Novack, Victor Hassan, Lior Reynolds, Teri A. PLoS One Research Article BACKGROUND: The impact of socioeconomic status on health has been established via a broad body of literature, largely from high-income countries. Investigative efforts in low- and middle-income countries have suffered from a lack of reporting standardization required to draw comparisons across countries of varying economic strata. In this study we aimed to evaluate the impact of socioeconomic status on emergency department outcomes in a low-income African country using international data classification systems. METHODS: This was a retrospective cohort study was conducted at a tertiary care center in northern Madagascar. Data were abstracted from paper charts into an electronic registry using Integrated Public Use Microdata Series codes for occupation, Nam-Powers-Boyd (NPB) scores for socioeconomic status, and Clinical Classifications Software ICD-9 equivalents for diagnosis. Outcome was dichotomized to the combined disposition of death or transfer directly to operating theater (OT) versus discharge. We used t-tests to compare baseline characteristics between these groups. We used chi-square analysis to test the association between occupational class and diagnosis. Finally, multivariate logistic regression analysis was performed examining the impact of NPB score on death/OT outcome, adjusting for age, gender, diagnosis and occupation. RESULTS: 5271 patients were seen during the 21-month study period with a death/OT rate of 9.7%. Older age and male gender were more common in death/OT patients (both p<0.001), and were shown to have positive odds ratios for this outcome in multivariate modeling (p<0.006 and <0.001). Occupational class was found to influence diagnosis for all classes (p<0.001) except Sales and Office. Adjusting for these 3 factors, we found a strong independent association between NPB quartile and death/OT outcome. Relative to the 1(st) quartile, the odds ratio in the 4(th) quartile was 2.9 (p = 0.004), the 3(rd) quartile 1.8 (p = 0.094), and the 2(nd) quartile 3.1 (p<0.001). CONCLUSION: To our knowledge, this is the first Malagasy study describing the relationship between socioeconomic status on emergency care outcomes. We found a stronger effect on health in this setting than in high-income countries, highlighting an important healthcare disparity. By using standardized classification systems we hope this study will serve as a model to facilitate future comparative efforts. Public Library of Science 2019-10-16 /pmc/articles/PMC6795438/ /pubmed/31618277 http://dx.doi.org/10.1371/journal.pone.0223045 Text en © 2019 Kannan et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kannan, Vijay C.
Rasamimanana, Giannie N.
Novack, Victor
Hassan, Lior
Reynolds, Teri A.
The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title_full The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title_fullStr The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title_full_unstemmed The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title_short The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis
title_sort impact of socioeconomic status on emergency department outcome in a low-income country setting: a registry-based analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795438/
https://www.ncbi.nlm.nih.gov/pubmed/31618277
http://dx.doi.org/10.1371/journal.pone.0223045
work_keys_str_mv AT kannanvijayc theimpactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT rasamimananagiannien theimpactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT novackvictor theimpactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT hassanlior theimpactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT reynoldsteria theimpactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT kannanvijayc impactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT rasamimananagiannien impactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT novackvictor impactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT hassanlior impactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis
AT reynoldsteria impactofsocioeconomicstatusonemergencydepartmentoutcomeinalowincomecountrysettingaregistrybasedanalysis