种族/民族与急性呼吸窘迫综合征：国家创伤数据库研究。

Race/ethnicity and acute respiratory distress syndrome: a National Trauma Data Bank study.

机构信息

Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.

出版信息

J Natl Med Assoc. 2010 Oct;102(10):865-9. doi: 10.1016/s0027-9684(15)30700-8.

DOI:10.1016/s0027-9684(15)30700-8

PMID:21053700

Abstract

BACKGROUND

A study in the general population has shown a higher acute respiratory distress syndrome (ARDS) mortality among blacks. We studied whether black blunt-trauma patients experience different ARDS incidence, ARDS-associated mortality, or ARDS case fatality rates.

METHODS

National Trauma Data Bank (NTDB) extracts of blunt-trauma patients with Injury Severity Score (ISS) greater than 16 and length of stay greater than 3 days were used for this study. ARDS incidence, ARDS-associated mortality, and ARDS case fatality rates were calculated for Caucasians, blacks, and Hispanics, and compared using chi2. In order to adjust for confounders (age, gender, comorbidities, hypotension, and injury severity) multiple logistic regression models were built for the 3 outcomes. Odd ratios (ORs) and 95% confidence intervals (CIs) were calculated. A p < .05 was used for all statistics.

RESULTS

Among the 96350 patients studied, ARDS incidence, ARDS-associated mortality, and ARDS case fatality rates were 0.92%, 0.18%, and 19.1%, respectively. Differences among racial/ethnic groups were found between blacks and Caucasians for ARDS incidence (0.70% vs. 0.93%) and between Hispanic and Caucasians for ARDS-associated mortality (0.27% vs. 0.17%). Multiple logistic regression models adjusting for confounders, using Caucasian race/ethnicity as a reference, revealed a protective effect of black race/ethnicity for ARDS incidence (OR, 0.73; 95% CI, 0.58-0.91). Hispanics, but not blacks, experienced higher odds of adjusted ARDS-associated mortality (OR, 1.76; 95% CI, 1.15-2.62) and ARDS case fatality (OR, 1.92; 95% CI, 1.17-3.09).

CONCLUSIONS

Black race/ethnicity is not associated with ARDS mortality among blunt-trauma patients. Black race/ethnicity seems to have a protective effect in relation to ARDS incidence. Hispanic ethnicity was associated with a higher mortality and case fatality rates for ARDS.

摘要

背景

一项针对普通人群的研究表明，黑人患急性呼吸窘迫综合征（ARDS）的死亡率更高。我们研究了黑人钝器创伤患者是否有不同的 ARDS 发病率、ARDS 相关死亡率或 ARDS 病死率。

方法

本研究使用国家创伤数据库（NTDB）中损伤严重程度评分（ISS）大于 16 分且住院时间大于 3 天的钝器创伤患者的提取数据。计算白种人、黑人和西班牙裔的 ARDS 发病率、ARDS 相关死亡率和 ARDS 病死率，并使用卡方检验进行比较。为了调整混杂因素（年龄、性别、合并症、低血压和损伤严重程度），为这 3 个结果建立了多个 logistic 回归模型。计算比值比（OR）和 95%置信区间（CI）。所有统计均采用 p<.05。

结果

在 96350 名患者中，ARDS 发病率、ARDS 相关死亡率和 ARDS 病死率分别为 0.92%、0.18%和 19.1%。在 ARDS 发病率方面，黑人和白种人之间存在种族差异（0.70%比 0.93%），在 ARDS 相关死亡率方面，西班牙裔和白种人之间存在种族差异（0.27%比 0.17%）。调整混杂因素后，以白种人种族为参考，多变量逻辑回归模型显示黑种人种族具有保护作用，可降低 ARDS 发病率（OR，0.73；95%CI，0.58-0.91）。与黑人不同，西班牙裔患者的 ARDS 相关死亡率（OR，1.76；95%CI，1.15-2.62）和 ARDS 病死率（OR，1.92；95%CI，1.17-3.09）的调整后比值更高。