Stein Paul D, Hull Russell D, Patel Kalpesh C, Olson Ronald E, Ghali William A, Alshab Andrew K, Meyers Frederick A
Research Department, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341-2985, USA.
Arch Intern Med. 2003;163(15):1843-8. doi: 10.1001/archinte.163.15.1843.
There has been concern that a disproportionate use of some health services exists among races. Whether this applies to patients with pulmonary embolism (PE) or deep venous thrombosis (DVT) has not been determined.
To assess if there is a racial disparity in the application of diagnostic tests for PE or DVT, or in reaching a diagnosis or using medical facilities.
A study of cross-sectional samples of hospitalizations during 21 years using data from the National Hospital Discharge Survey.
Noninstitutional hospitals in 50 states and the District of Columbia from January 1, 1979, through December 31, 1999.
The National Hospital Discharge Survey abstracts demographic and medical information from the medical records of inpatients. For 1979 through 1999, the number of patients sampled ranged annually from 181 000 to 307 000. Measurements The number of sampled patients with DVT and with PE and the number of diagnostic tests performed were determined from the International Classification of Diseases, Ninth Revision, Clinical Modification codes at discharge. A multistage estimation procedure gave an estimate of values for the entire United States.
The age-adjusted rates of diagnosis of PE and of DVT per 100 000 population were not lower in blacks than in whites. Rates of use of radioisotopic lung scans, venous ultrasonography of the lower extremities, and contrast venography were comparable between races. The durations of hospitalization for patients with a primary discharge diagnosis of PE and of DVT were also comparable.
There is nothing to suggest that diagnostic tests are being withheld, and there is no evidence of a failure to reach a diagnosis in blacks with thromboembolic disease.
人们一直担心不同种族在某些医疗服务的使用上存在不均衡现象。这是否适用于肺栓塞（PE）或深静脉血栓形成（DVT）患者尚未确定。
评估在PE或DVT诊断检查的应用、确诊或医疗设施使用方面是否存在种族差异。
一项利用国家医院出院调查数据对21年住院横断面样本进行的研究。
1979年1月1日至1999年12月31日期间美国50个州和哥伦比亚特区的非机构医院。
国家医院出院调查从住院患者的病历中提取人口统计学和医疗信息。1979年至1999年，每年抽样患者数量在181000至307000之间。测量方法根据出院时的《国际疾病分类，第九版，临床修订本》编码确定抽样的DVT和PE患者数量以及进行的诊断检查数量。采用多阶段估计程序得出美国整体的估计值。
每10万人口中经年龄调整的PE和DVT诊断率在黑人中并不低于白人。种族间放射性核素肺扫描、下肢静脉超声检查和静脉造影的使用率相当。初次出院诊断为PE和DVT的患者住院时间也相当。
没有迹象表明黑人被扣留诊断检查，也没有证据表明血栓栓塞性疾病的黑人患者未得到确诊。
