Huber T S, Wang J G, Wheeler K G, Cuddeback J K, Dame D A, Ozaki C K, Flynn T C, Seeger J M
Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
J Vasc Surg. 1999 Sep;30(3):417-25. doi: 10.1016/s0741-5214(99)70068-6.
The purpose of this study was to determine the impact of race on the treatment of peripheral artery occlusive disease (PAOD) and to examine the role of access to care and disease distribution on the observed racial disparity.
The study was performed as a retrospective analysis of hospital discharge abstracts from 1992 to 1995 in 202 non-federal, acute-care hospitals in the state of Florida. The subjects were patients older than 44 years of age who underwent major lower extremity amputation or revascularization (bypass grafting or angioplasty) for PAOD. The main outcome measures were incidence of intervention, incidence per demographic group, multivariate predictors of amputation versus revascularization, multivariate predictors of amputation versus revascularization among those patients with access to sophisticated care (hospital with arteriographic capabilities), and multivariate predictors of surgical bypass graft type (aortoiliac vs infrainguinal).
A total of 51,819 procedures (9.1 per 10,000 population) were performed for PAOD during the study period and included 15,579 major lower extremity amputations (30.1%) and 36,240 revascularizations (69.9%). Although the incidence of a procedure for PAOD was comparable between African Americans and whites (9.0 vs 9.6 per 10, 000 demographic group), the incidence of amputation (5.0 vs 2.5 per 10,000 demographic group) was higher and the incidence of revascularization (4.0 vs 7.1 per 10,000 demographic group) was lower among African Americans. Furthermore, multivariate analysis results showed that African Americans (odds ratio, 3.79; 95% confidence interval [CI], 3.34 to 4.30) were significantly more likely than whites to undergo amputation as opposed to revascularization. The secondary multivariate analyses results revealed that African Americans (odds ratio, 2.29; 95% CI, 1.58 to 3. 33) were more likely to undergo amputation among those patients (n = 9193) who underwent arteriography during the procedural admission and to undergo infrainguinal bypass grafting (odds ratio, 2.00; 95% CI, 1.48 to 2.71) among those patients (n = 27,796) who underwent surgical bypass grafting.
There is a marked racial disparity in the treatment of patients with PAOD that may be caused in part by differences in the severity of disease or disease distribution.
本研究旨在确定种族对周围动脉闭塞性疾病（PAOD）治疗的影响，并探讨获得医疗服务的机会和疾病分布在观察到的种族差异中所起的作用。
本研究对佛罗里达州202家非联邦急症护理医院1992年至1995年的医院出院摘要进行回顾性分析。研究对象为44岁以上因PAOD接受下肢大截肢或血运重建术（搭桥手术或血管成形术）的患者。主要观察指标包括干预发生率、各人口统计学组的发生率、截肢与血运重建的多变量预测因素、在能够获得先进医疗服务（具备血管造影能力的医院）的患者中截肢与血运重建的多变量预测因素，以及手术搭桥类型（主髂动脉搭桥与腹股沟下搭桥）的多变量预测因素。
研究期间共进行了51,819例PAOD相关手术（每10,000人口中有9.1例），其中包括15,579例下肢大截肢（30.1%）和36,240例血运重建（69.9%）。尽管非裔美国人和白人的PAOD手术发生率相当（每10,000人口中分别为9.0例和9.6例），但非裔美国人的截肢发生率（每10,000人口中为5.0例）更高，血运重建发生率（每10,000人口中为4.0例）更低。此外，多变量分析结果显示，与白人相比，非裔美国人接受截肢而非血运重建的可能性显著更高（比值比，3.79；95%置信区间[CI]，3.34至4.30）。二次多变量分析结果显示，在手术入院期间接受血管造影的患者（n = 9193）中，非裔美国人接受截肢的可能性更大（比值比，2.29；95%CI，1.58至3.33）；在接受手术搭桥的患者（n = 27,796）中，非裔美国人接受腹股沟下搭桥的可能性更大（比值比，2.00；95%CI，1.48至2.71）。
PAOD患者的治疗存在明显的种族差异，这可能部分是由疾病严重程度或疾病分布的差异所致。
