Qian Feng, Fonarow Gregg C, Smith Eric E, Xian Ying, Pan Wenqin, Hannan Edward L, Shaw Benjamin A, Glance Laurent G, Peterson Eric D, Eapen Zubin J, Hernandez Adrian F, Schwamm Lee H, Bhatt Deepak L
Department of Health Policy, Management & Behavior, School of Public Health,University at Albany-State University of New York, Albany, NY 12144, USA.
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):284-92. doi: 10.1161/CIRCOUTCOMES.113.000211. Epub 2013 May 16.
Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS.
We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines-Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21-1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11-1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74-0.94]).
Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.
关于急性缺血性卒中（AIS）的长期预后是否因种族/民族而异，目前所知甚少。利用美国心脏协会“遵循指南-卒中”注册库与医疗保险索赔数据集相链接的数据，我们研究了老年AIS患者中30天和1年的预后是否因种族/民族而有所不同。
我们分析了来自美国926个中心的200900例年龄>65岁的AIS患者（170694例非西班牙裔白人，占85.0%；20514例非西班牙裔黑人，占10.2%；6632例西班牙裔，占3.3%；3060例非西班牙裔亚裔美国人，占1.5%），这些患者于2003年4月至2008年12月参加了“遵循指南-卒中”项目。与白人相比，其他种族和民族群体平均年龄较小，且美国国立卫生研究院卒中量表的中位数得分较高。白人的30天未经调整的死亡率高于其他群体（白人、黑人、西班牙裔、亚裔分别为15.0%、9.9%、11.9%、11.1%）。白人的1年未经调整的死亡率也较高（分别为31.7%、28.6%、28.1%、23.9%），但1年未经调整的全因再住院率较低（分别为54.7%、62.5%、60.0%、48.6%）。在进行风险调整后，AIS亚裔美国患者的30天和1年死亡率低于白人、黑人和西班牙裔患者。相对于白人，黑人和西班牙裔患者调整后的1年全因再住院率较高（黑人：调整后的比值比为1.28[95%置信区间为1.21-1.37]；西班牙裔：调整后的比值比为1.22[95%置信区间为1.11-1.35]），而亚裔患者的比值较低（调整后的比值比为0.83[95%置信区间为0.74-0.94]）。
在患有AIS的老年医疗保险受益人中，即使在对卒中严重程度、其他预后变量和医院特征进行调整后，长期预后在种族/民族方面仍存在显著差异。
