Nguyen Geoffrey C, Bayless Theodore M, Powe Neil R, Laveist Thomas A, Brant Steven R
Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Inflamm Bowel Dis. 2007 Nov;13(11):1408-16. doi: 10.1002/ibd.20200.
Racial disparities in utilization of major surgical procedures have been well documented in the United States over the last decade. Crohn's disease (CD) is a chronically relapsing disorder that leads to significant morbidity and, in most cases, surgery. Our objective was to characterize health disparities in CD-related bowel resection among hospitalized CD patients.
We analyzed discharge records from the Nationwide Inpatient Sample, the largest nationally representative database of acute-care hospitals throughout the United States. A total of 41,918 discharges with CD from 1998 to 2003 were included. Bowel resection and in-hospital mortality rates for non-Hispanic whites, African Americans, Hispanics, and non-Hispanic Asians were calculated.
After adjusting for age, sex, health insurance, comorbidity, median neighborhood income, and hospital characteristics, the relative rate ratio of undergoing bowel resection for African Americans, Hispanics, and Asians compared to whites was 0.68 (95% confidence interval [CI]: 0.61-0.76), 0.70 (95% CI: 0.60-0.83), and 0.31 (95% CI: 0.16-0.59), respectively. Compared to those with private insurance, the relative risk of surgery for those with Medicare, those with Medicaid, and those who were "self-pay" was 0.48 (95% CI: 0.44-0.54), 0.52 (95% CI: 0.46-0.59), and 0.67 (95% CI: 0.58-0.77), respectively. Women were less likely than men to undergo bowel resection (incidence rate ratio [IRR] = 0.80; 95% CI: 0.76-0.85). The in-hospital mortality of individuals who resided in neighborhoods whose median income was above the national median was lower (IRR = 0.71; 95% CI: 0.50-0.99).
Bowel resection among hospitalized CD patients varies by race, health insurance, and sex. Further mechanistic studies are needed to elucidate the social and biological underpinnings of these variations.
在过去十年中，美国主要外科手术的使用存在种族差异，这一点已有充分记录。克罗恩病（CD）是一种慢性复发性疾病，会导致严重的发病率，并且在大多数情况下需要进行手术。我们的目标是描述住院的CD患者中与CD相关的肠道切除术的健康差异。
我们分析了全国住院患者样本中的出院记录，该样本是美国最大的具有全国代表性的急性护理医院数据库。纳入了1998年至2003年期间共41918例患有CD的出院病例。计算了非西班牙裔白人、非裔美国人、西班牙裔和非西班牙裔亚洲人的肠道切除率和住院死亡率。
在对年龄、性别、医疗保险、合并症、社区收入中位数和医院特征进行调整后，非裔美国人、西班牙裔和亚洲人相对于白人接受肠道切除术的相对率比分别为0.68（95%置信区间[CI]：0.61 - 0.76）、0.70（95%CI：0.60 - 0.83）和0.31（95%CI：0.16 - 0.59）。与拥有私人保险的人相比，拥有医疗保险、医疗补助保险和“自费”的人进行手术的相对风险分别为0.48（95%CI：0.44 - 0.54）、0.52（95%CI：0.46 - 0.59）和0.67（95%CI：0.58 - 0.77）。女性接受肠道切除术的可能性低于男性（发病率比[IRR] = 0.80；95%CI：0.76 - 0.85）。居住在收入中位数高于全国中位数社区的个体的住院死亡率较低（IRR = 0.71；95%CI：0.50 - 0.99）。
住院CD患者的肠道切除术因种族、医疗保险和性别而异。需要进一步的机制研究来阐明这些差异的社会和生物学基础。
