Manhapra Ajay, Canto John G, Vaccarino Viola, Parsons Lori, Kiefe Catarina I, Barron Hal V, Rogers William J, Weaver W Douglas, Borzak Steven
Inpatient Medical Specialists, Department of Internal Medicine, Hackley Hospital-Spectrum Health, Muskegon, Mich 49443, USA.
Am Heart J. 2004 Jul;148(1):92-8. doi: 10.1016/j.ahj.2004.02.010.
Prior studies have suggested that young blacks with acute myocardial infarction (AMI) may have higher hospital mortality rates than whites of similar age. However, the influence of age and race on short-term death has not been explored in detail. We examined the relation of age and race on short-term death in a large AMI population and ascertained the factors that may have contributed to differences in mortality rates.
We compared the crude and adjusted hospital mortality rates stratified by age among 40,903 blacks and 501,995 whites with AMI enrolled in the National Registry of Myocardial Infarction-2 in 1482 participating US hospitals from June 1994 through March 1998.
Overall crude mortality was lower among blacks compared with whites (10.9% vs 12.0%, P <.0001). However, blacks had a significantly higher crude mortality rate compared with the whites in the age groups <65 years (<45 years, and 5-year age groups between 45 and 64 years). There was a statistically significant interaction between age and black race on hospital death (P value for interaction <.001). Each 5-year decrement in age from 85 years was associated with 7.2% higher odds of death in blacks compared with whites (95% CI, 5.7% to 7.6%). After adjusting for differences in the baseline, clinical presentation, early treatment, and hospital characteristics, 5-year decrements in age was still associated with increases in the odds for death in blacks compared with whites (5.4%; 95% CI, 3.6% to 7.2%). This interaction between age and black race was present in both sexes but was stronger among men.
Blacks younger than 65 years had higher hospital mortality rates compared with whites hospitalized for AMI, and decreasing age was associated with progressively higher risk of hospital death for blacks. Differences in the clinical presentation, early treatment, and hospital characteristics could only partly explain this age-race interaction.
先前的研究表明，患有急性心肌梗死（AMI）的年轻黑人可能比年龄相仿的白人有更高的医院死亡率。然而，年龄和种族对短期死亡的影响尚未得到详细探讨。我们研究了在一大群急性心肌梗死患者中年龄和种族与短期死亡的关系，并确定了可能导致死亡率差异的因素。
我们比较了1994年6月至1998年3月期间在美国1482家参与医院登记的40903名患有急性心肌梗死的黑人和501995名白人按年龄分层的粗死亡率和调整后的医院死亡率。
总体而言，黑人的粗死亡率低于白人（10.9%对12.0%，P<.0001）。然而，在<65岁年龄组（<45岁以及45至64岁之间的5岁年龄组）中，黑人的粗死亡率显著高于白人。年龄与黑人种族在医院死亡方面存在统计学上的显著交互作用（交互作用P值<.001）。与白人相比，从85岁起每5岁年龄递减，黑人死亡几率增加7.2%（95%CI，5.7%至7.6%）。在对基线、临床表现、早期治疗和医院特征的差异进行调整后，与白人相比，每5岁年龄递减仍与黑人死亡几率增加相关（5.4%；95%CI，3.6%至7.2%）。年龄与黑人种族之间的这种交互作用在两性中均存在，但在男性中更强。
与因急性心肌梗死住院的白人相比，年龄小于65岁的黑人有更高的医院死亡率，并且年龄降低与黑人医院死亡风险逐渐升高相关。临床表现、早期治疗和医院特征的差异只能部分解释这种年龄 - 种族交互作用。
