美国印第安人和阿拉斯加原住民与加利福尼亚州因缺血性心脏病住院的非西班牙裔白人相比的心脏手术。
Cardiac procedures among American Indians and Alaska Natives compared to non-Hispanic whites hospitalized with ischemic heart disease in California.
机构信息
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
出版信息
J Gen Intern Med. 2010 May;25(5):430-4. doi: 10.1007/s11606-009-1235-y. Epub 2010 Jan 27.
BACKGROUND
American Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population.
OBJECTIVE
To determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina.
DESIGN
Cross-sectional study. EVENTS: A total of 796 ischemic heart disease hospitalizations among AIAN and 90971 among non-Hispanic whites in 37 of 58 counties in California from 1998-2002.
MEASUREMENTS
Cardiac catheterization, percutaneous cardiac intervention, and coronary artery bypass graft surgery procedure rates from hospitalization administrative data.
MAIN RESULTS
AIAN did not have lower cardiac procedure rates for cardiac catheterization and percutaneous cardiac intervention compared to non-Hispanic whites (unadjusted OR 1.00, 95% CI 0.87-1.16 and OR 1.04, 95% CI 0.90-1.20, respectively). Adjustment for age, sex, comorbidities, and payer source did not alter the results (adjusted OR 0.95, 95% CI 0.82-1.10 and OR 0.98, 95% CI 0.85-1.14, respectively). We found higher odds (unadjusted OR 1.36, 95% CI 1.09-1.70) for receipt of coronary artery bypass graft surgery among AIAN hospitalized for ischemic heart disease compared to non-Hispanic whites which after adjustment attenuated some and was no longer statistically significant (adjusted OR 1.26, 95% CI 1.00-1.58).
CONCLUSION
AIAN were not less likely to receive cardiac procedures as non-Hispanic whites during hospitalizations for ischemic heart disease. Additional research is needed to determine whether differences in specialty referral patterns, patients' treatment preferences, or outpatient management may explain some of the health disparities due to cardiovascular disease that is found among AIAN.
背景
美洲印第安人/阿拉斯加原住民（AIAN）患心血管疾病的负担很重，其致命和非致命性心脏病的发病率比美国人口高两倍左右。
目的
确定与因缺血性心脏病住院的非西班牙裔白人相比，加利福尼亚州因缺血性心脏病住院的 AIAN 患者的心脏手术率是否存在差异，缺血性心脏病定义为急性心肌梗死或不稳定型心绞痛。
设计
横断面研究。
事件
1998 年至 2002 年间，加利福尼亚州 58 个县中的 37 个县的 796 例 AIAN 和 90971 例非西班牙裔白人的缺血性心脏病住院患者。
测量
从住院管理数据中获取心脏导管插入术、经皮冠状动脉介入术和冠状动脉旁路移植术的手术率。
主要结果
与非西班牙裔白人相比，AIAN 患者的心脏导管插入术和经皮冠状动脉介入术的心脏手术率没有降低（未调整的 OR 1.00，95%CI 0.87-1.16 和 OR 1.04，95%CI 0.90-1.20）。调整年龄、性别、合并症和支付者来源后，结果并未改变（调整后的 OR 0.95，95%CI 0.82-1.10 和 OR 0.98，95%CI 0.85-1.14）。我们发现，与非西班牙裔白人相比，因缺血性心脏病住院的 AIAN 患者接受冠状动脉旁路移植术的可能性更高（未调整的 OR 1.36，95%CI 1.09-1.70），但调整后该比值有所降低，且不再具有统计学意义（调整后的 OR 1.26，95%CI 1.00-1.58）。
结论
在因缺血性心脏病住院期间，AIAN 患者接受心脏手术的可能性与非西班牙裔白人患者没有差异。需要进一步研究以确定专科转诊模式、患者治疗偏好或门诊管理方面的差异是否可以解释 AIAN 中发现的部分心血管疾病导致的健康差异。
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