Copeland Laurel A, Zeber John E, Pugh Mary Jo, Phillips Karon L, Lawrence Valerie A
Central Texas Veterans Health Care System, Research Service, Temple, TX 76502, USA.
Depress Res Treat. 2011;2011:370962. doi: 10.1155/2011/370962. Epub 2011 Oct 12.
To examine equity in one aspect of care provision in the Veterans Health Administration, this study analyzed factors associated with receipt of coronary artery bypass graft (CABG), vascular, hip/knee, or digestive system surgeries during FY2006-2009. A random sample of patients (N = 317, 072) included 9% with depression, 17% African-American patients, 5% Hispanics, and 5% women. In the four-year followup, 18,334 patients (6%) experienced surgery: 3,109 hip/knee, 3,755 digestive, 1,899 CABG, and 11,330 vascular operations. Patients with preexisting depression were less likely to have surgery than nondepressed patients (4% versus 6%). In covariate-adjusted analyses, minority patients were slightly less likely to receive vascular operations compared to white patients (Hispanic OR = 0.88, P < .01; African-American OR = 0.93, P < .01) but more likely to undergo digestive system procedures. Some race-/ethnicity-related disparities of care for cardiovascular disease may persist for veterans using the VHA.
为研究退伍军人健康管理局（Veterans Health Administration）医疗服务某一方面的公平性，本研究分析了2006财年至2009财年期间接受冠状动脉搭桥术（CABG）、血管手术、髋关节/膝关节手术或消化系统手术的相关因素。随机抽取的患者样本（N = 317,072）中，9%患有抑郁症，17%为非裔美国患者，5%为西班牙裔，5%为女性。在四年的随访中，18,334名患者（6%）接受了手术：3,109例髋关节/膝关节手术、3,755例消化系统手术、1,899例冠状动脉搭桥术和11,330例血管手术。已有抑郁症的患者接受手术的可能性低于无抑郁症的患者（4%对6%）。在协变量调整分析中，与白人患者相比，少数族裔患者接受血管手术的可能性略低（西班牙裔比值比[OR] = 0.88，P <.01；非裔美国OR = 0.93，P <.01），但接受消化系统手术的可能性更高。对于使用退伍军人健康管理局医疗服务的退伍军人而言，一些与种族/族裔相关的心血管疾病护理差异可能仍然存在。
