Deswal Anita, Petersen Nancy J, Souchek Julianne, Ashton Carol M, Wray Nelda P
Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Coll Cardiol. 2004 Mar 3;43(5):778-84. doi: 10.1016/j.jacc.2003.10.033.
The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization.
To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity.
In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge.
The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small.
In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization.
本研究的目的是确定在财务上“平等获取”医疗保健系统——退伍军人健康管理局（VA）中，因充血性心力衰竭（CHF）住院的全国患者队列中的种族死亡率差异，并研究住院后医疗保健利用模式的种族差异。
为了解释观察到的CHF住院黑人患者再入院率增加和死亡率降低的矛盾现象，有人推测黑人患者可能获得门诊护理的机会减少，导致因疾病严重程度较轻而住院的次数更多。
在一项对153家VA医院中4901名因CHF住院的黑人和17093名白人退伍军人的回顾性研究中，我们评估了30天和2年时的死亡率，以及出院后一年的医疗保健利用情况。
黑人与白人患者30天和2年死亡率的风险调整比值比（OR）分别为0.70（95%置信区间[CI]0.60至0.82）和0.84（95%CI0.78至0.91）。在出院后的一年中，黑人的再入院率与白人相同。黑人的门诊就诊率低于白人，急诊/急诊室就诊率高于白人，尽管这些差异很小。
在一个医疗保健获取平等的系统中，医疗保健利用模式的种族差距很小。CHF住院后黑人患者生存率更高这一观察结果，不能轻易地用医疗保健利用差异来解释。
