Riegel Barbara, Moser Debra K, Rayens Mary Kay, Carlson Beverly, Pressler Susan J, Shively Martha, Albert Nancy M, Armola Rochelle R, Evangelista Lorraine, Westlake Cheryl, Sethares Kristen
University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania 19104-6096, USA.
J Card Fail. 2008 Feb;14(1):41-7. doi: 10.1016/j.cardfail.2007.09.008.
Chronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure.
Data for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire.
Significant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients.
Cultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients.
慢性病给某些群体带来的负担比其他群体更重。在对患有慢性病的种族/族裔群体的研究中，一些研究者发现了与健康相关的生活质量（HRQL）存在差异，而另一些研究者则未发现。在心力衰竭患者中进行的此类比较很少。本研究的目的是比较非西班牙裔白人、黑人和西班牙裔成年心力衰竭患者的HRQL。
这项纵向比较研究的数据来自美国西南部、东南部、西北部、东北部和中西部的八个地点。本分析使用了1212名患者的入组数据以及3个月和6个月的数据。倾向得分用于调整种族/族裔群体之间的社会人口统计学和临床差异。使用明尼苏达心力衰竭生活问卷来测量与健康相关的生活质量。
显示出显著的种族/族裔效应，即使在调整了基线分数、年龄、性别、教育程度、疾病严重程度和护理环境（急性与慢性）并估计治疗效果（干预与常规护理）之后，西班牙裔患者在基线后明尼苏达心力衰竭生活问卷总分比黑人和白人患者更有利。基于身体和情感子量表分数的模型相似，事后比较表明西班牙裔患者比非西班牙裔白人患者有更积极的结果。
在对慢性病的理解和反应方面的文化差异可能解释了为什么与白人和黑人患者相比，西班牙裔心力衰竭患者的HRQL随时间改善得更多。
