Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury

입원 중증 손상 환자의 사망과 전원에 영향을 미치는 요인에 관한 다수준분석

  • Choi, Young Eun (Department of Public Health, The Graduate School of Catholic University) ;
  • Lee, Kang Suk (Department of Preventive Medicine, The Catholic University of Korea College of Medicine)
  • 최영은 (가톨릭대학교 대학원 보건학과) ;
  • 이강숙 (가톨릭대학교 의과대학 예방의학교실)
  • Received : 2013.02.13
  • Accepted : 2013.08.04
  • Published : 2013.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study was conducted to evaluate the individual and community level factors which were influencing the severe injury patients' death and transfer at discharge. Methods: Analysis data is based on Korean National Hospital Discharge In-depth Survey Data released by the Korea Center for Disease Control and Prevention from 2006 to 2008. Study subjects was 11,026 inpatients with of severe injury. For multi-level analysis, socio-demographic characteristics, injury related characteristics, hospitalization related characteristics were used as individual level factors, and socio-environmental characteristics and health care resource characteristics were used as community level factors. Results: As to community level factors affecting mortality of severe injury, the possibility of death was also high in cases of less numbers of surgeons per a population of 100,000 and more number of operation beds. As to community level factors affecting transfer of severe injury, vulnerable areas with higher social deprivation index and low population density had higher possibility of transfer. Conclusion: Both individual level factors and community level factors affected clinical outcomes of treatment for severe injury. In particular, since there happened higher death and transfer of severe injury in socioeconomic and medical vulnerable areas, special efforts for establishing preventive policy and care system for injury in national and area level should be directed toward such areas.

Keywords

References

  1. Statistics Korea. 2011 Result on the cause of death statistics. Daejeon: Statistics Korea; 2012.
  2. Park K, Lee JS, Kim Y, Kim YI, Kim J. The socioeconomic cost of injuries in South Korea. J Prev Med Public Health 2009;42(1):5-11. https://doi.org/10.3961/jpmph.2009.42.1.5
  3. Heffernan DS, Vera RM, Monaghan SF, Thakkar RK, Kozloff MS, Connolly MD, et al. Impact of socioethnic factors on outcomes following traumatic brain injury. J Trauma 2011;70(3):527-534. https://doi.org/10.1097/TA.0b013e31820d0ed7
  4. Lee EJ, Lee JS, Kim Y, Park K, Eun SJ, Suh SK, et al. Patterns of unintentional domestic injuries in Korea. J Prev Med Public Health 2010;43(1): 84-92. https://doi.org/10.3961/jpmph.2010.43.1.84
  5. Jung SW, Cho YT. Neighborhood characteristics and individual health under Korean context. J Prev Med Public Health 2005;38(3):259-266.
  6. Laflamme L, Diderichsen F. Social differences in traffic injury risks in childhood and youth: a literature review and a research agenda. Inj Prev 2000;6(4):293-298. https://doi.org/10.1136/ip.6.4.293
  7. Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Inj Prev 2011;17(2):119-126. https://doi.org/10.1136/ip.2010.026989
  8. Males MA. Poverty as a determinant of young drivers' fatal crash risks. J Safety Res 2009;40(6):443-448. https://doi.org/10.1016/j.jsr.2009.10.001
  9. Traynor TL. The relationship between regional economic conditions and the severity of traffic crashes. Traffic Inj Prev 2009;10 (4):368-374. https://doi.org/10.1080/15389580902995174
  10. Maio RF, Green PE, Becker MP, Burney RE, Compton C. Rural motor vehicle crash mortality: the role of crash severity and medical resources. Accid Anal Prev 1992;24(6):631-642. https://doi.org/10.1016/0001-4575(92)90015-B
  11. Kristensen P, Kristiansen T, Rehn M, Gravseth HM, Bjerkedal T. Social inequalities in road traffic deaths at age 16-20 years among all 611,654 Norwegians born between 1967 and 1976: a multilevel analysis. Inj Prev 2012;18(1):3-9. https://doi.org/10.1136/ip.2011.031682
  12. Vane DW, Shackford SR. Epidemiology of rural traumatic death in children: a population-based study. J Trauma 1995;38(6):867-870. https://doi.org/10.1097/00005373-199506000-00006
  13. Durkin MS, Davidson LL, Kuhn L, O'Connor P, Barlow B. Low-income neighborhoods and the risk of severe pediatric injury: a small-area analysis in northern Manhattan. Am J Public Health 1994;84(4):587-592. https://doi.org/10.2105/AJPH.84.4.587
  14. Chang DC, Eastman B, Talamini MA, Osen HB, Tran Cao HS, Coimbra R. Density of surgeons is significantly associated with reduced risk of deaths from motor vehicle crashes in US counties. J Am Coll Surg 2011; 212(5):862-866. https://doi.org/10.1016/j.jamcollsurg.2011.01.057
  15. Rutledge R, Fakhry SM, Baker CC, Weaver N, Ramenofsky M, Sheldon GF, et al. A population-based study of the association of medical manpower with county trauma death rates in the United States. Ann Surg 1994;219(5):547-563. https://doi.org/10.1097/00000658-199405000-00013
  16. Kim MH, Subramanian SV. Kawachi I, Kim CY. Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study. J Epidemiol Community Health 2007;61: 135-140. https://doi.org/10.1136/jech.2006.047738
  17. Park KH. Spatio-temporal distributions of unintentional injury mortality and influencing factors [dissertation]. Seoul: Seoul National University; 2009.
  18. Lee JS, Kim Y, Jeoung GY, Park HS, Kim JY, Eun SJ, et al. Accidents statistics DB construction and the present state analysis. Seoul: Seoul National University Hospital, National Health Insurance Service; 2007.
  19. Ko YK. Identification of factors related to hospital nurses' organizational citizenship behavior using a multilevel analysis. Taehan Kanho Hakhoe Chi 2008;38(2):287-297.
  20. Kim YH, Cho YT. Impact of area characteristics on the health of vulnerable populations in Seoul. Korean J Popul Stud 2008;31(1):1-26.
  21. Kim CS, Yun SC, Kim HR, Khang YH. A multilevel study on the relationship between the residential distribution of high class (power elites) and smoking in Seoul. J Prev Med Public Health 2006;39(1):30-38.
  22. Korea Center for Disease Control and Prevention. Korean national hospital discharge in-depth injury survey. Cheongwon: Korea Center for Disease Control and Prevention; 2008.
  23. Hanyang University. Health promotion strategies and programmes development for health inequalities alleviation. Seoul: Hanyang University; 2009.
  24. Statistics Korea. Regional essential data. Daejeon: Statistics Korea; 2010.
  25. Seoul National University. Analysis of vulnerable area and monitoring in emergency medical service and efficient support plan in emergency medical resources. Seoul: Seoul National University; 2009.
  26. National Emergency Medical Center. 2007 Emergency medical statistics. Seoul: National Emergency Medical Center; 2008.
  27. Jung JH, Kwon SM, Kim KH, Lee SK, Kim DS. Impact of health insurance type on the quality of hemodialysis services: a multilevel analysis. J Prev Med Public Health 2010;43(3):245-256. https://doi.org/10.3961/jpmph.2010.43.3.245
  28. Saadat S, Akbari H, Khorramirouz R, Mofid R, Movaghar VR. Determinants of mortality in patients with traumatic brain injury. Ulus Travma Acil Cerrahi Derg 2012;18(3):219-224. https://doi.org/10.5505/tjtes.2012.03453
  29. Donate-Lopez C, Espigares-Rodriguez E, Jimenez-Moleon JJ, Luna-del-Castillo Jde D, Bueno-Cavanillas A, Lardelli-Claret P. The association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles involved in traffic crashes in Spain. Accid Anal Prev 2010;42(1):297-306. https://doi.org/10.1016/j.aap.2009.08.007
  30. Kim KH, Noh M, Ha ID. A study using HGLM on regional difference of the dead due to injuries. J Korean Data Inf Sci Soc 2011;22 (2):137-148.
  31. Kim JH, Kim SP, Kim SJ, Cho SH, Cho NS. Analysis of the factors that influence the severity of injury of pedestrian traffic accident patients in an emergency department. J Korean Soc Emerg Med 2010;21(5):561-568.
  32. Dunn CW, Donovan DM, Gentilello LM. Practical guidelines for performing alcohol interventions in trauma centers. J Trauma 1997;42(2): 299-304. https://doi.org/10.1097/00005373-199702000-00021
  33. Desai A, Bekelis K, Zhao W, Ball PA. Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States. J Neurosurg 2012;117(3):599-603. https://doi.org/10.3171/2012.6.JNS111281
  34. Katsaragakis S, Drimousis PG, Kleidi ES, Toutouzas K, Lapidakis E, Papadakis G, et al. Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality. Scand J Trauma Resusc Emerg Med 2010;18:14. https://doi.org/10.1186/1757-7241-18-14
  35. Gupta R, Greer SE, Martin ED. Inefficiencies in a rural trauma system: the burden of repeat imaging in interfacility transfers. J Trauma 2010; 69(2):253-255. https://doi.org/10.1097/TA.0b013e3181e4d579
  36. Ahn KO, Hong JY, Kim Y, Jung KY. Appropriate interhospital transfer of emergent patients. J Korean Soc Emerg Med 2006;17(2):138-145.
  37. Jung KW, Jang JM, Kim J, Baek SJ, Song SY, Gang CS, et al. Delayed transfer of major trauma patients under the current emergency medical system in Korea. J Korean Soc Traumatol 2011;24(1):25-30.
  38. Han SS, Jung K, Kwon J, Kim J, Choi SC, Lee KJ. Problems with transferring major trauma patients to emergency medical center of a university hospital from another medical center. J Korean Soc Traumatol 2011; 24(2):118-124.
  39. Cubbin C, LeClere FB, Smith GS. Socioeconomic status and injury mortality: individual and neighbourhood determinants. J Epidemiol Community Health 2000;54(7):517-524. https://doi.org/10.1136/jech.54.7.517
  40. Lee HW, Park JH, Kang SH, Kim WJ. A study on self-sufficiency for hospital injury inpatients in Korea. J Korea Acad Ind Coop Soc 2011;12(12): 5779-5788. https://doi.org/10.5762/KAIS.2011.12.12.5779

Cited by

  1. The effect of contextual factors on unintentional injury hospitalization: from the Korea National Hospital Discharge Survey vol.18, pp.1, 2018, https://doi.org/10.1186/s12889-018-5249-4