Center for Management of Complex Chronic Care, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA.
Am J Cardiol. 2010 Mar 1;105(5):694-700. doi: 10.1016/j.amjcard.2009.10.051.
Heart failure (HF) disproportionately affects black compared to white Americans, and overall mortality from HF is greater among blacks. Paradoxically, mortality rates after a hospitalization for HF are lower in black than in white patients. These racial differences might reflect hospital, physician, and patient factors and could have implications for comparative hospital profiles. We identified published studies reporting the posthospitalization mortality for black and white patients with a discharge diagnosis of HF and conducted random-effects meta-analyses with the outcome of all-cause mortality. We included 29 cohorts of hospitalized black and white patients with HF. The unadjusted mean mortality rate after HF hospitalization for black and white patients, respectively, was 6% and 9% for in-hospital, 6% and 10% for 30-day, 10% and 15% for 60- to 180-day, 28% and 34% for 1-year, and 41% and 47% for >1-year follow-up, respectively. The unadjusted combined odds ratios for mortality in black versus white patients ranged from 0.48 for in-hospital (95% confidence interval [CI] 0.45 to 0.51) to 0.77 after >1 year follow-up (95% CI 0.75 to 0.79). In meta-analyses using adjusted data, the combined odds ratio was 0.68 for short-term mortality (95% CI 0.63 to 0.74), and the combined hazard ratio was 0.84 for long-term mortality (95% CI 0.77 to 0.91). In conclusion, mortality after hospitalization for HF was 32% lower during short-term follow-up and 16% lower during long-term follow-up for black than for white patients. The mortality differences imply unmeasured differences by race in clinical severity of illness at hospital admission and might lead to biased hospital mortality profiles.
心力衰竭（HF）在黑人群体中的发病率明显高于白人群体，且 HF 总死亡率在黑人群体中更高。矛盾的是，HF 住院患者的死亡率在黑人患者中比在白人患者中更低。这些种族差异可能反映了医院、医生和患者的因素，并可能对医院的比较概况产生影响。我们确定了发表的研究报告，这些研究报告了黑人患者和白人患者在因 HF 出院后的住院死亡率，并对全因死亡率的结果进行了随机效应荟萃分析。我们纳入了 29 个 HF 住院黑人患者和白人患者队列。HF 住院后，未经调整的黑人患者和白人患者的死亡率分别为：住院期间 6%和 9%，30 天内 6%和 10%，60-180 天内 10%和 15%，1 年内 28%和 34%，>1 年内随访 41%和 47%。未经调整的黑人患者与白人患者的死亡率比值比范围从住院期间的 0.48（95%置信区间[CI] 0.45 至 0.51）到>1 年后随访的 0.77（95%CI 0.75 至 0.79）。在使用调整后数据进行的荟萃分析中，短期死亡率的合并比值比为 0.68（95%CI 0.63 至 0.74），长期死亡率的合并风险比为 0.84（95%CI 0.77 至 0.91）。总之，HF 住院患者在短期随访期间的死亡率比白人患者低 32%，在长期随访期间的死亡率比白人患者低 16%。这些死亡率差异意味着，在入院时的疾病严重程度方面，种族存在未被测量到的差异，并且可能导致医院死亡率概况存在偏差。
