社会资本与医疗保险受益人手术获取的关系研究

本研究旨在比较在不同社会资本水平的普查区内，医疗保险受益人因访问敏感性手术疾病发生的非计划手术比例。访问敏感性手术疾病是指理想情况下应在门诊环境中筛查和治疗的疾病。然而，若未及时治疗，这些疾病可能导致非计划（即急诊或突发）手术。社会资本——指个体通过社会网络获得的资源——可能影响计划手术的发生概率。研究对象为2016至2020年期间接受三种访问敏感性手术（腹主动脉瘤修复、癌症结肠切除术和腹壁疝修补术）的Medicare受益人，按其所在普查区的社会资本水平进行分层。主要结局指标包括非计划手术发生率、再入院率、30天死亡率和并发症，采用风险调整的逻辑回归模型，控制患者年龄、性别、种族、合并症及区域贫困程度。共纳入975,048名受益人（平均[标准差]患者年龄76岁[7.6岁]；其中男性443,190人[45.45%]）。与来自最高社会资本十个百分点的普查区的患者相比，来自社会资本最低区的患者更可能发生非计划手术（40.67%对35.28%，比值比=1.26，P<0.001）。此外，这些社区的受益人也更易出现术后并发症（24.99%对22.90%，比值比=1.12，P<0.001），但在再入院和死亡率方面无显著差异。在仅评估择期手术时，最低与最高社会资本组在并发症方面的差异显著减小（12.77%对12.11%，比值比=1.06，P=0.04），死亡率差异消失，重返院率差异仍不显著。这些数据表明，居住在社会资本较低社区的Medicare受益人更可能发生访问敏感性疾病的非计划手术。改善这些社区的社会资本，可能成为降低非计划手术发生率的策略之一。

To compare the rates of unplanned procedures for access-sensitive surgical conditions among beneficiaries living in census tracts of varying social capital levels.Access-sensitive surgical conditions are conditions ideally screened for and treated in an elective setting. However, when left untreated, these conditions may result in unplanned (i.e., urgent or emergent) surgery. It is possible that social capital-the resources available to individuals through their membership in a social network-may impact the likelihood of a planned procedure occurring.Medicare beneficiaries who underwent one of three access-sensitive procedures (abdominal aortic aneurysm repair, colectomy for cancer, and ventral hernia repair) between 2016-2020 were stratified by their census tract level of social capital, the exposure variable. Outcomes included rate of unplanned surgery, readmission, 30-day mortality, and complications which were risk-adjusted with a logistic regression model that accounted for patient age, sex, race, comorbidities, and area deprivation.A total of 975,048 beneficiaries were included (mean [SD] patient age, 76 [7.6] years; 443,190 were male [45.45%]). Compared to patients from census tracts in the highest overall social capital decile, those from census tracts with the least social capital were on average more likely to undergo unplanned surgery (40.67% versus 35.28%, OR=1.26 P<0.001). Additionally, beneficiaries in these communities were also more likely to experience postoperative complications (24.99% versus 22.90%, OR=1.12 P<0.001), but there was no significant difference in rates of readmission or mortality. When evaluating only elective procedures, the differences between the lowest and highest social capital decile groups reduced significantly for complications (12.77% versus 12.11%, OR=1.06 P=0.04), the differences in mortality rates collapsed, and differences in readmission rates remained insignificant.These data suggest that Medicare beneficiaries who live in communities with lower social capital are more likely to undergo unplanned surgery for access-sensitive conditions. Efforts to improve social capital in these communities may be one strategy for reducing the rate of unplanned operations.