Philbin E F, McCullough P A, DiSalvo T G, Dec G W, Jenkins P L, Weaver W D
Division of Cardiology, Albany Medical College, mail Code-44, 47 New Scotland Avenue, Albany, NY 12208, USA.
Circulation. 2000 Nov 7;102(19 Suppl 3):III107-15. doi: 10.1161/01.cir.102.suppl_3.iii-107.
Patient and hospital characteristics influence the use of invasive cardiac procedures. Whether socioeconomic status (SES) has an influence that is independent of these other determinants is unclear. The purpose of the present study was to examine the influence of household income as a measure of SES on the use of invasive cardiac procedures among a large group of patients with acute myocardial infarction.
We analyzed administrative discharge data from 231 nonfederal acute care hospitals in New York State that involved 28 698 black or white inpatients with International Classification of Diseases, Ninth Revision, Clinical Modification code 410.XX in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. The use of cardiac catheterization, PTCA, CABG, and any revascularization procedure was examined across groups stratified by income. Patients who resided in lower-income neighborhoods were more often female or black, had a higher prevalence of coexistent illness, had a higher use of Medicaid insurance, and were less often admitted to urban hospitals or hospitals that provide on-site CABG and PTCA. Crude and adjusted odds ratios for catheterization, PTCA, CABG, and any revascularization procedure were related to income in a graded fashion. After adjustment, patients in the highest quintile of income were 22% more likely to undergo catheterization, 74% more likely to undergo PTCA, 48% more likely to undergo CABG, and 76% more likely to undergo any revascularization procedure than were patients in the lowest quintile. The difference in cardiac catheterization did not fully account for income-based differences in revascularization, because income remained a significant determinant of revascularization after accounting for whether a catheterization was performed. Even among patients treated in hospitals that provide on-site CABG and PTCA, income was a significant determinant of procedures.
Lower-income patients hospitalized for acute myocardial infarction are more often female or black, have more coexisting illnesses, and are less often admitted to urban hospitals or hospitals that provide CABG and PTCA. Even after adjustment for these and other factors, lower income is a negative predictor of procedure use.
患者及医院特征会影响侵入性心脏手术的使用。社会经济地位（SES）是否具有独立于其他决定因素的影响尚不清楚。本研究的目的是在一大群急性心肌梗死患者中，检验作为SES衡量指标的家庭收入对侵入性心脏手术使用情况的影响。
我们分析了纽约州231家非联邦急症医院的行政出院数据，这些数据涉及1995年1月1日至12月31日期间主要诊断部位为国际疾病分类第九版临床修订本代码410.XX的28698名黑种或白种住院患者。家庭收入源自邮政邮政编码和人口普查数据。在按收入分层的各组中，对心脏导管插入术、经皮冠状动脉腔内血管成形术（PTCA）、冠状动脉旁路移植术（CABG）及任何血运重建手术的使用情况进行了检查。居住在低收入社区的患者女性或黑人比例更高，并存疾病患病率更高，医疗补助保险使用率更高，入住城市医院或提供现场CABG和PTCA的医院的可能性更低。导管插入术、PTCA、CABG及任何血运重建手术的粗比值比和调整后比值比与收入呈分级相关。调整后，收入最高五分位数的患者接受导管插入术的可能性比最低五分位数的患者高22%，接受PTCA的可能性高74%，接受CABG的可能性高48%，接受任何血运重建手术的可能性高76%。心脏导管插入术的差异并不能完全解释基于收入的血运重建差异，因为在考虑是否进行导管插入术后，收入仍是血运重建的重要决定因素。即使在提供现场CABG和PTCA的医院接受治疗的患者中，收入仍是手术的重要决定因素。
因急性心肌梗死住院的低收入患者女性或黑人比例更高，并存疾病更多，入住城市医院或提供CABG和PTCA的医院的可能性更低。即使对这些及其他因素进行调整后，低收入仍是手术使用的负面预测因素。
