基于人群的脑卒中后入住重症监护病房的种族差异分析。

A population-based analysis of ethnic differences in admission to the intensive care unit after stroke.

机构信息

Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA.

出版信息

Neurocrit Care. 2012 Dec;17(3):348-53. doi: 10.1007/s12028-012-9770-5.

DOI:10.1007/s12028-012-9770-5

PMID:22892883

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3520600/

Abstract

BACKGROUND

Mexican-Americans (MAs) have shown lower post-stroke mortality compared to non-hispanic whites (NHWs). Limited evidence suggests race/ethnic differences exist in intensive care unit (ICU) admissions following stroke. Our objective was to investigate the association of ethnicity with admission to the ICU following stroke.

METHODS

Cases of intracerebral hemorrhage and acute ischemic stroke were prospectively ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project for the period of January 2000 through December 2009. Logistic regression models fitted within the generalized additive model framework were used to test associations between ethnicity and ICU admission and potential confounders. An interaction term between age and ethnicity was investigated in the final model.

RESULTS

A total 1,464 cases were included in analysis. MAs were younger, more likely to have diabetes, and less likely to have atrial fibrillation, health insurance, or high school diploma than NHWs. On unadjusted analysis, there was a trend toward MAs being more likely to be admitted to ICU than NHWs (34.6 vs 30.3 %; OR = 1.22; 95 % CI 0.98-1.52; p = 0.08). However, on adjusted analysis, no overall association between MA ethnicity and ICU admission (OR = 1.13; 95 % CI 0.85-1.50) was found. When an interaction term for age and ethnicity was added to this model, there was only borderline evidence for effect modification by age of the ethnicity/ICU relationship (p = 0.16).

CONCLUSIONS

No overall association between ethnicity and ICU admission was observed in this community. ICU utilization alone does not likely explain ethnic differences in survival following stroke between MAs and NHWs.

摘要

背景

与非西班牙裔白人（NHWs）相比，墨西哥裔美国人（MAs）在中风后死亡率较低。有限的证据表明，中风后入住重症监护病房（ICU）存在种族/民族差异。我们的目的是调查种族与中风后入住 ICU 的关系。

方法

2000 年 1 月至 2009 年 12 月，作为大脑攻击监测在科珀斯克里斯蒂（BASIC）项目的一部分，前瞻性确定了脑出血和急性缺血性中风的病例。使用广义加性模型框架内的逻辑回归模型来检验种族与 ICU 入院和潜在混杂因素之间的关联。在最终模型中研究了年龄和种族之间的交互项。

结果

共纳入 1464 例患者。与 NHWs 相比，MAs 更年轻，更有可能患有糖尿病，而不太可能患有心房颤动、医疗保险或高中文凭。在未调整的分析中，MAs 比 NHWs 更有可能被收入 ICU 的趋势（34.6%比 30.3%；OR=1.22；95%CI 0.98-1.52；p=0.08）。然而，在调整分析中，MA 种族与 ICU 入院之间没有总体关联（OR=1.13；95%CI 0.85-1.50）。当在该模型中添加年龄和种族的交互项时，仅发现年龄对种族/ICU 关系的影响修饰存在边缘证据（p=0.16）。