社会风险干预和小儿哮喘的卫生服务利用: 系统评价和荟萃分析

2022/04/19

   摘要
   重要性:健康的社会决定因素(SDOH)与小儿哮喘的发病率相关,但解决社会风险的干预措施是否与儿童哮喘的结果相关,目前尚不清楚。
   目的:按社会风险对哮喘干预措施进行分类,并综合其与儿童哮喘相关的急诊科(ED)就诊和住院的关系。
   数据来源:检索了2008年1月1日至2021年6月16日期间的PubMed、Scopus、PsycINFO、SocINDEX、CINAHL以及收录的全文文章的参考文献。
   研究选择:纳入的文章是基于美国的研究,评估针对1个或多个社会风险的干预措施与儿童哮喘相关的ED就诊和住院的关系。系统评价包括最初641篇确定的文章中的38篇(6%),荟萃分析包括19篇(3%)。
   数据提取与综合:数据提取遵循《系统评价和荟萃分析报告指南》的首选报告项目。通过使用 "健康2020 "的SDOH框架,根据其解决的社会风险对研究进行分组,从而确定SDOH干预集群。随机效应模型创建了集合风险比(RRs)作为效应估计。
   主要结果与措施:ED就诊或住院的病人是主要结果。亚组分析是按SDOH干预组进行的。对每项研究都进行了敏感性分析,去除离群的研究和未达最低质量阈值的研究。
   结果:总共有38项研究被纳入系统回顾,其中19项研究为荟萃分析提供数据(共5441名参与者)。所有的干预措施都涉及健康、环境和社区领域中的一个或多个领域;没有干预措施侧重于经济或教育领域。在主要分析中,社会风险干预措施与减少ED就诊(RR,0.68;95%CI,0.57-0.81;I2=70%)和住院(RR,0.50;95%CI,0.37-0.68;I2=69%)有关。在亚组分析中,与其他干预组相比,健康、环境和社区干预组产生的ED就诊(RR,0.53;95%CI,0.44-0.64;I2 = 50%)和住院(RR,0.33;95%CI,0.20-0.55;I2 = 71%)的RR最低。敏感性分析没有改变主要或亚组效应估计。
   结论和意义:这一系统回顾和荟萃分析的结果表明,社会风险干预措施与儿童哮喘相关的急诊和住院的减少有关。这些发现表明,解决社会风险可能是小儿哮喘护理的一个重要组成部分,以改善健康结果。

 
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(JAMA Pediatr. 2022 Feb 1;176(2):e215103. DOI:10.1001/jamapediatrics.2021.5103)
 
 
 
Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis.
 
Jordan Tyris, Susan Keller, Kavita Parikh
 
Abstract
IMPORTANCE:Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes among children is unclear.
OBJECTIVE:To catalog asthma interventions by the social risks they address and synthesize their associations with asthma-related emergency department (ED) visits and hospitalizations among children.
DATA SOURCES:PubMed, Scopus, PsycINFO, SocINDEX, CINAHL, and references of included full-text articles were searched from January 1, 2008, to June 16, 2021.
STUDY SELECTION:Included articles were US-based studies evaluating the associations of interventions addressing 1 or more social risks with asthma-related ED visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%).
DATA EXTRACTION AND SYNTHESIS:Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The SDOH intervention clusters were identified by grouping studies according to the social risks they addressed, using the Healthy People 2020 SDOH framework. Random-effects models created pooled risk ratios (RRs) as the effect estimates.
MAIN OUTCOMES AND MEASURES:Patients with ED visits or hospitalizations were the primary outcomes. Subgroup analyses were conducted by an SDOH intervention cluster. Sensitivity analyses were conducted for each, removing outlier studies and studies failing to meet the minimum quality threshold.
RESULTS:In total, 38 studies were included in the systematic review, with 19 of these studies providing data for the meta-analysis (5441 participants). All interventions addressed 1 or more of the health, environment, and community domains; no interventions focused on the economy or education domains. In the primary analysis, social risk interventions were associated with decreased ED visits (RR, 0.68; 95% CI, 0.57-0.81; I2 = 70%) and hospitalizations (RR, 0.50; 95% CI, 0.37-0.68; I2 = 69%). In subgroup analyses, the health, environment, and community intervention cluster produced the lowest RR for ED visits (RR, 0.53; 95% CI, 0.44-0.64; I2 = 50%) and for hospitalizations (RR, 0.33; 95% CI, 0.20-0.55; I2 = 71%) compared with other intervention clusters. Sensitivity analyses did not alter primary or subgroup effect estimates.
CONCLUSIONS AND RELEVANCE:The results of this systematic review and meta-analysis indicate that social risk interventions are associated with decreased asthma-related ED visits and hospitalizations among children. These findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.




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