Central Arkansas Veterans Healthcare System and Department of Internal Medicine, University of Arkansas for Medical Sciences, and Department of Biostatistics, College of Public Health, Little Rock, Arkansas.
Am J Cardiol. 2010 Apr 1;105(7):1019-23. doi: 10.1016/j.amjcard.2009.11.031. Epub 2010 Feb 13.
Previous reports have suggested that blacks receive life-saving cardioprotective therapies less often than whites, probably because of a lower socioeconomic status, which leads to poor access to physicians. We questioned whether racial disparity existed in the Veterans Affairs Healthcare System. We examined the Veterans' Integrated Service Network (VISN 16) database with regard to the prescription rates for 4 cardiovascular agents-aspirin, beta blockers, statins, and angiotensin-converting enzyme inhibitors. The database, encompassing 474,565 patients (117,071 blacks and 357,494 whites), was analyzed. Cardioprotective drugs were prescribed significantly less often to black patients than compared to white patients (beta blockers 19.7% vs 24.8%, odds ratio [OR] 0.74, 95% confidence interval [CI] 0.72 to 0.75; statins 20.5% vs 30.2%, OR 0.54, 95% CI 0.52 to 0.55; and angiotensin-converting enzyme inhibitors 27.7% vs 30.0%, OR 0.94, 95% CI 0.92 to 0.96; all p <0.0001, after adjustment for all covariates used in the analysis). Nonetheless, the prescription rates for aspirin were greater among the black patients than among the white patients (OR 1.31, 95% CI 1.27 to 1.35, p <0.001) after adjustment. The black patients received coronary artery bypass grafting less often than did the white patients (0.4% vs 1.21%, OR 0.40% to 0.48%, 95% CI 1.34 to 1.42, p <0.001). After adjustment for the use of cardioprotective drugs and coronary artery bypass grafting, black patients still had greater odds of developing angina (OR 1.38, 95% CI 1.34 to 1.42, p <0.001) and acute myocardial infarction (OR 1.11, 95% CI 1.03 to 1.19, p <0.006) than did white patients in the Department of Veterans Affairs Veterans' Integrated Service Network 16 hospitals. In conclusion, the lower prescription rates of cardioprotective drugs and lower rates of coronary artery bypass grafting might be a partial basis for the high rates of cardiac morbidity among black patients.
先前的报告表明，与白人相比，黑人接受救命的心脏保护治疗的频率较低，这可能是由于较低的社会经济地位导致他们获得医生的机会较差。我们质疑在退伍军人事务医疗保健系统中是否存在种族差异。我们检查了退伍军人综合服务网络（VISN 16）数据库，研究了 4 种心血管药物——阿司匹林、β受体阻滞剂、他汀类药物和血管紧张素转换酶抑制剂的处方率。该数据库包含 474565 名患者（117071 名黑人患者和 357494 名白人患者），对其进行了分析。与白人患者相比，黑人患者接受心脏保护药物治疗的比例明显较低（β受体阻滞剂为 19.7%对 24.8%，比值比[OR]为 0.74，95%置信区间[CI]为 0.72 至 0.75；他汀类药物为 20.5%对 30.2%，OR 为 0.54，95%CI 为 0.52 至 0.55；血管紧张素转换酶抑制剂为 27.7%对 30.0%，OR 为 0.94，95%CI 为 0.92 至 0.96；所有 p 值均<0.0001，在分析中调整了所有协变量）。然而，黑人患者的阿司匹林处方率高于白人患者（OR 为 1.31，95%CI 为 1.27 至 1.35，p 值<0.001）。与白人患者相比，黑人患者接受冠状动脉旁路移植术的比例较低（0.4%对 1.21%，OR 为 0.40%至 0.48%，95%CI 为 1.34 至 1.42，p 值<0.001）。在调整心脏保护药物和冠状动脉旁路移植术的使用后，黑人患者发生心绞痛（OR 为 1.38，95%CI 为 1.34 至 1.42，p 值<0.001）和急性心肌梗死（OR 为 1.11，95%CI 为 1.03 至 1.19，p 值<0.006）的几率仍高于退伍军人事务部退伍军人综合服务网络 16 家医院的白人患者。总之，心脏保护药物的处方率较低和冠状动脉旁路移植术的比例较低可能是黑人患者心脏发病率较高的部分原因。
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