Abstract:
OBJECTIVES:To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization. DESIGN:Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics. We considered a 0.05 unit increase in the Gini coefficient as a measure of income inequality. SETTING:US acute care hospitals. PARTICIPANTS:Patients aged 65 years and older, and hospitalized in 2006-08 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia. MAIN OUTCOME MEASURES:Risk of death within 30 days of admission or rehospitalization for any cause within 30 days of discharge. The potential number of excess deaths and readmissions associated with higher levels of inequality in US states in the three highest quarters of income inequality were compared with corresponding data in US states in the lowest quarter. RESULTS:Mortality analyses included 555,962 admissions (4348 hospitals) for acute myocardial infarction, 1,092,285 (4484) for heart failure, and 1,146,414 (4520); readmission analyses included 553,037 (4262), 1,345,909 (4494), and 1,345,909 (4524) admissions, respectively. In 2006-08, income inequality in US states (as measured by the average Gini coefficient over three years) varied from 0.41 in Utah to 0.50 in New York. Multilevel models showed no significant association between income inequality and mortality within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia. By contrast, income inequality was associated with rehospitalization (acute myocardial infarction, risk ratio 1.09 (95% confidence interval 1.03 to 1.15), heart failure 1.07 (1.01 to 1.12), pneumonia 1.09 (1.03 to 1.15)). Further adjustment for individual income and educational achievement did not significantly attenuate these findings. Over the three year period, we estimate an excess of 7153 (2297 to 11,733) readmissions for acute myocardial infarction, 17,991 (3410 to 31,772) for heart failure, and 14,127 (4617 to 23,115) for pneumonia, that are associated with inequality levels in US states in the three highest quarters of income inequality, compared with US states in the lowest quarter. CONCLUSIONS:Among patients hospitalized with acute myocardial infarction, heart failure, and pneumonia, exposure to higher levels of income inequality was associated with increased risk of readmission but not mortality. In view of the observational design of the study, these findings could be biased, owing to residual confounding.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Lindenauer PK,Lagu T,Rothberg MB,Avrunin J,Pekow PS,Wang Y,Krumholz HMdoi
10.1136/bmj.f521subject
Has Abstractpub_date
2013-02-14 00:00:00pages
f521eissn
0959-8138issn
1756-1833journal_volume
346pub_type
杂志文章abstract:OBJECTIVES:To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. DESIGN:Retrospective analysis of nationally representative surveys conducted by th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h706
更新日期:2015-02-18 00:00:00
abstract:OBJECTIVE:To characterise the clinical features of patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United Kingdom during the growth phase of the first wave of this outbreak who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Hea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m1985
更新日期:2020-05-22 00:00:00
abstract:OBJECTIVE:To evaluate risk of late life coronary heart disease associated with being overweight in late middle or old age and to assess whether weight change modifies this risk. DESIGN:Longitudinal study of subjects in the epidemiological follow up study of the national health and nutrition examination survey I. SETT...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7097.1791
更新日期:1997-06-21 00:00:00
abstract::The numbers of patients being admitted to hospital with aortic aneurysms have increased recently. A study was carried out to try to find out whether this was a true increase in incidence or whether it could be attributable to more accurate diagnosis and better surgical techniques. From analyses of routine statistics i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6665.33
更新日期:1989-01-07 00:00:00
abstract:OBJECTIVE:To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN:Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7061.848
更新日期:1996-10-05 00:00:00
abstract:OBJECTIVE:To assess predictors of mortality in a population of people prescribed methadone. DESIGN:Retrospective cohort study. SETTING:Geographically defined population in Tayside, Scotland. PARTICIPANTS:2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004. MAIN OUTCOME MEASU...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b2225
更新日期:2009-06-16 00:00:00
abstract:OBJECTIVE:To determine whether the use of inhaled corticosteroids during pregnancy increases the risk of pregnancy induced hypertension and pre-eclampsia among asthmatic women. DESIGN:Nested case-control study. SETTING:Three administrative health databases from Quebec: RAMQ, MED-ECHO, and Fichier des evenements demog...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38313.624352.8F
更新日期:2005-01-29 00:00:00
abstract:OBJECTIVE:To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. DESIGN:Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (2300). SETTING:Metab...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6709.1202
更新日期:1989-11-11 00:00:00
abstract:OBJECTIVES:To examine the association between environmental exposure to takeaway food outlets, takeaway food consumption, and body weight, while accounting for home, work place, and commuting route environments. DESIGN:Population based, cross sectional study, using data on individual participants' diet and weight, and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.g1464
更新日期:2014-03-13 00:00:00
abstract:OBJECTIVE:To define the benefit of rice oral rehydration salts solution in relation to the glucose based World Health Organisation oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea. DESIGN:Meta-analysis using data from 13 available randomised trials t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.304.6822.287
更新日期:1992-02-01 00:00:00
abstract:OBJECTIVE:To compare the mortality of patients in a palliative care unit on working days with that on weekends and public holidays. DESIGN:Retrospective database study. SETTING:Palliative care unit in Germany. POPULATION:All admissions to palliative care unit between 1 January 1997 and 31 December 2008. MAIN OUTCOM...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.g7370
更新日期:2014-12-16 00:00:00
abstract:OBJECTIVE:To design and evaluate a computer advisory system for the treatment of gestational trophoblastic tumour. DESIGN:A comparison of clinicians' treatment decisions with those of the computer system. Two datasets were used: one to calibrate the system and one to independently evaluate it. SETTING:Department of m...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6857.804
更新日期:1992-10-03 00:00:00
abstract:OBJECTIVES:To identify the genetic determinants of fracture risk and assess the role of 15 clinical risk factors on osteoporotic fracture risk. DESIGN:Meta-analysis of genome wide association studies (GWAS) and a two-sample mendelian randomisation approach. SETTING:25 cohorts from Europe, United States, east Asia, an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.k3225
更新日期:2018-08-29 00:00:00
abstract:OBJECTIVE:To characterise the percentage of available outcome data being presented in reports of randomised clinical trials with continuous outcome measures, thereby determining the potential for incomplete reporting bias. DESIGN:Descriptive cross sectional study. DATA SOURCES:A random sample of 200 randomised trials...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e8486
更新日期:2012-12-18 00:00:00
abstract::WHO is under pressure from all sides to justify its existence. Donors want to know what they are getting for their money, and health professionals question the relevance of the organisation's work. The pressure to justify itself is perhaps strongest of all in Europe, where most member countries have fully fledged heal...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6976.389
更新日期:1995-02-11 00:00:00
abstract:OBJECTIVE:To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. DESIGN:Cluster randomised controlled trial over 20 weeks. SETTING:Family compou...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38512.618681.E0
更新日期:2005-09-03 00:00:00
abstract:OBJECTIVES:To assess the performance of a panel of common single nucleotide polymorphisms (genotypes) associated with type 2 diabetes in distinguishing incident cases of future type 2 diabetes (discrimination), and to examine the effect of adding genetic information to previously validated non-genetic (phenotype based)...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b4838
更新日期:2010-01-14 00:00:00
abstract::A total of 563 white primigravid patients at Raigmore Hospital, Inverness, were recruited in a prospective study to examine the association between maternal height, shoe size, and the outcome of labour. There was a significantly increased caesarean section rate in women of short stature but no association between mode...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6647.515
更新日期:1988-08-20 00:00:00
abstract:OBJECTIVES:To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration. DESIGN:Prospective, randomized, 52 week, single blind comparative effec...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.k851
更新日期:2018-03-21 00:00:00
abstract:OBJECTIVES: To estimate differences in annual income of physicians in the United States by race and sex adjusted for characteristics of physicians and practices. DESIGN: Cross sectional survey study. SETTING: Nationally representative samples of US physicians. PARTICIPANTS: The 2000-13 American Community Survey (ACS...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i2923
更新日期:2016-06-07 00:00:00
abstract:OBJECTIVE:To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors. DESIGN:Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. PARTICIPANTS:5,260,292 US Air F...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.327.7428.1376
更新日期:2003-12-13 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression. DESIGN:Three arm parallel cluster randomised controlled trial. SETTING:Eight UK secondary schools. PARTICIPANTS:Adolescents (n=5030) ag...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e6058
更新日期:2012-10-05 00:00:00
abstract:OBJECTIVE:To study the association between wheezy symptoms in young children and the presence of bacteria in the airways. DESIGN:Birth cohort study. SETTING:Clinical research unit in Copenhagen. PARTICIPANTS:Children of asthmatic mothers, from age 4 weeks to 3 years, with planned visits and acute admissions to the r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c4978
更新日期:2010-10-04 00:00:00
abstract:OBJECTIVES:To identify risk factors predisposing to the development of flucloxacillin associated jaundice. DESIGN:Case-control study. Medical records of cases and controls were reviewed and information recorded on standard data collection forms. SETTING:Alfred Hospital recruiting subjects from Melbourne, Sydney, and ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6872.233
更新日期:1993-01-23 00:00:00
abstract:OBJECTIVE:To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS. DESIGN:Follow-up of cluster randomised trial 4.5 years after intervention. SETTING:NHS records of women who...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39014.503692.55
更新日期:2007-01-20 00:00:00
abstract:OBJECTIVE:To study the relation between low walking speed and the risk of death in older people, both overall and with regard to the main causes of death. DESIGN:Prospective cohort study. SETTING:Dijon centre (France) of the Three-City study. PARTICIPANTS:3208 men and women aged >or=65 living in the community, recru...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b4460
更新日期:2009-11-10 00:00:00
abstract::The aim of the study was to assess whether increased energy expenditure causes the negative energy balance (tissue catabolism) commonly seen in children with insulin dependent (type I) diabetes. Resting metabolic rate and thermogenesis induced by adrenaline were measured in five healthy children and 14 children with t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6697.487
更新日期:1989-08-19 00:00:00
abstract:OBJECTIVES:To examine a possible effect on labour of training the muscles of the pelvic floor during pregnancy. DESIGN:Randomised controlled trial. SETTING:Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting. PARTICIPANTS:301 healthy nulliparous women randomly allocated...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38163.724306.3A
更新日期:2004-08-14 00:00:00
abstract:OBJECTIVE:To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population. DESIGN:Parallel group randomised controlled trial. SETTING:Primary health centre in a deprived, ethnically mixed inner city area. PARTICIPANTS:...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.326.7394.855
更新日期:2003-04-19 00:00:00
abstract:OBJECTIVE:To document the relative importance of endogenous sex steroids in modulating the frequency of orgasms, the dominant aspect of sexual behaviour in healthy eugonadal men. DESIGN:Measurement of adrenal and testicular sex steroids in a sample of army recruits and study of their relation to frequency of orgasms a...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6990.1289
更新日期:1995-05-20 00:00:00