National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
Med Care Res Rev. 2011 Apr;68(2):226-46. doi: 10.1177/1077558710379421. Epub 2010 Sep 9.
Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men, to receive an ICD (adjusted OR = 0.48; 95% CI = 0.34-0.67). In this cohort, these differences appear related to overutilization among men and Whites who are discordant with ICD placement criteria in addition to underutilization among Blacks concordant with placement criteria.
先前的研究记录了在植入式心脏复律除颤器（ICD）放置方面存在种族和性别差异。作者研究了 ICD 放置方面的种族和性别差异是否是由于利用不足或过度利用造成的。在一家大型学术医院中，2001 年至 2004 年期间因室性心律失常住院的 1054 名成年人中，研究发现 17%的患者有与 ICD 放置标准相符的临床指标。在这些患者中，黑人接受 ICD 治疗的可能性低于白人（校正优势比 [OR] = 0.24；95%CI = 0.08-0.71）。在 83%不符合 ICD 放置标准的患者中，黑人（校正 OR = 0.30；95%CI = 0.18-0.52）和西班牙裔（校正 OR = 0.24，95%CI = 0.10-0.57）接受 ICD 治疗的可能性低于白人，女性接受 ICD 治疗的可能性低于男性（校正 OR = 0.48；95%CI = 0.34-0.67）。在该队列中，这些差异似乎与不符合 ICD 放置标准的男性和白人的过度利用以及符合放置标准的黑人的利用不足有关。
