以色列南部贝都因人和犹太人在急性心肌梗死后结局的性别和种族差异。

Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in southern Israel.

机构信息

Unit of Nursing Research, Soroka University Medical Center, Beer-Sheva, Israel.

出版信息

Eur J Public Health. 2011 Feb;21(1):74-80. doi: 10.1093/eurpub/ckq012. Epub 2010 Mar 2.

DOI:10.1093/eurpub/ckq012

PMID:20197314

Abstract

BACKGROUND

Previous studies have documented gender-ethnic disparities in outcomes following acute myocardial infarction (AMI). This study evaluates such disparities in the Negev, Israel, and reviews potentially responsible mechanisms.

METHODS

Patients discharged with AMI were classified into young (<70 years), elders (≥70 years) and gender-ethnicity groups: Female Bedouins (FB), Female Jews (FJ), Male Bedouins (MB) and Male Jews (MJ). The primary outcome was 1-year all-cause mortality. Prognosis was assessed using Kaplan-Meier approach. Multivariable analyses assessing hazard ratios (HRs) for mortality were performed using the Cox proportional hazards regression models in two steps controlling for (i) the Ontario Acute Myocardial Infarction Mortality Prediction Rules (OAMIMPRs) and (ii) the OAMIMPR and additional potential confounders.

RESULTS

Of 2669 subjects, 45.8% were elders, 66.2% male and 10.9% Bedouin. The mortality rate was 12.3% (young 4.6%, elders 22%). Survival was significantly lower in FB compared with MB in the elderly stratum (P = 0.025). Multivariate analyses demonstrated similar risks for dying among the young. In the elders, the first multivariate analysis showed greater risk for mortality in FB. Using FB as the reference group, the HRs were as follows: HR((MB)) = 0.36 [95% confidence interval (CI): 0.14-0.9]; HR((FJ)) = 0.5 (95% CI: 0.27-0.9) and HR((MJ)) = 0.5 (95% CI: 0.28-0.91). In the second analysis, the HRs were as follows: HR((MB)) = 0.37 (95% CI: 0.14-0.93); HR((FJ)) = 0.58 (95% CI: 0.32-1.07) and HR((MJ)) = 0.56 (95% CI: 0.31-1.03).

CONCLUSIONS

Elderly FB have poor 1-year prognosis following AMI compared with MB, MJ and FJ when controlling for the OAMIMPR model, yet when controlling for other potential confounders the differences are of borderline significance in relation to Jewish subjects. A culturally and economically sensitive programme focusing on tertiary prevention in these patients is warranted.

摘要

背景

先前的研究记录了急性心肌梗死（AMI）后在结局方面存在性别-种族差异。本研究评估了以色列内盖夫的此类差异，并回顾了潜在的相关机制。

方法

将出院时患有 AMI 的患者分为年轻（<70 岁）、老年（≥70 岁）和性别-种族组：女性贝都因人（FB）、女性犹太人（FJ）、男性贝都因人（MB）和男性犹太人（MJ）。主要结局是 1 年全因死亡率。使用 Kaplan-Meier 方法评估预后。使用 Cox 比例风险回归模型在两步中进行多变量分析，以评估死亡率的危险比（HRs），在控制（i）安大略省急性心肌梗死死亡率预测规则（OAMIMPRs）和（ii）OAMIMPR 和其他潜在混杂因素后。

结果

在 2669 名患者中，45.8%为老年人，66.2%为男性，10.9%为贝都因人。死亡率为 12.3%（年轻组为 4.6%，老年组为 22%）。在老年患者中，FB 的生存率明显低于 MB（P=0.025）。多变量分析显示，年轻患者的死亡风险相似。在老年人中，第一份多变量分析显示 FB 组的死亡率风险更高。使用 FB 作为参考组，HR 如下：HR（MB）=0.36[95%置信区间（CI）：0.14-0.9]；HR（FJ）=0.5（95%CI：0.27-0.9）和 HR（MJ）=0.5（95%CI：0.28-0.91）。在第二项分析中，HR 如下：HR（MB）=0.37[95%CI：0.14-0.93]；HR（FJ）=0.58[95%CI：0.32-1.07]和 HR（MJ）=0.56[95%CI：0.31-1.03]。