Wang Tom Kai Ming, Ramanathan Tharumenthiran, Stewart Ralph, Crengle Sue, Gamble Greg, White Harvey
Green Lane Cardiovascular Service, Auckland City Hospital. Private Bag 92024, Victoria St West, Auckland 1142, New Zealand.
N Z Med J. 2013 Aug 2;126(1379):12-22.
Disparities for Maori exist in New Zealand for cardiovascular risk factors, events and access to revascularisation. We compared characteristics and outcomes of coronary artery bypass grafting (CABG) between Maori and Europeans in New Zealand.
Patients undergoing isolated CABG at Auckland City Hospital from July 2010-June 2012 were retrospectively analysed.
Of 818 patients, 82 were Maori and 444 were Europeans. Maori were younger (60.0 vs 67.9 years, p<0.001), had higher NZ deprivation index (8.5 vs 5.0, p<0.001), body mass index (32.6 vs 28.8 kg/m2, p<0.001), higher prevalence of heart failure (11.0% vs 2.3%, p<0.001), diabetes (43.9% vs 24.1%, p<0.001), smoking (39.0% vs 13.1%, p<0.001), dialysis (4.9% vs 0.9%, p=0.023), lower ejection fraction (p=0.001), lower additive EuroSCORE 1 (4.1 vs 4.8, p=0.041) and longer cardiopulmonary bypass time (100 vs 89 minutes p<0.001). Maori ethnicity was independently associated with 30-day mortality, odds ratio (OR) 6.35, 95% confidence interval 1.01-39.9, p=0.046; and surgical morbidity OR 2.05, 1.04-4.04, p=0.040. Maori had a trend for higher mortality at 1.4 plus or minus 0.6 years (hazards ratio 2.91, 0.92-9.20, p=0.069), 1-year mortality 6.3% vs 1.5%.
Despite being younger, Maori undergoing CABG had more comorbidities and socioeconomic deprivation. Maori had higher mortality and complication rates. Maori should have earlier access to CABG.
在新西兰，毛利人在心血管危险因素、疾病事件以及血管重建治疗机会方面存在差异。我们比较了新西兰毛利人和欧洲人冠状动脉旁路移植术（CABG）的特征及结果。
对2010年7月至2012年6月在奥克兰市医院接受单纯CABG手术的患者进行回顾性分析。
818例患者中，82例为毛利人，444例为欧洲人。毛利人更年轻（60.0岁对67.9岁，p<0.001），新西兰贫困指数更高（8.5对5.0，p<0.001），体重指数更高（32.6kg/m²对28.8kg/m²，p<0.001），心力衰竭患病率更高（11.0%对2.3%，p<0.001），糖尿病患病率更高（43.9%对24.1%，p<0.001），吸烟率更高（39.0%对13.1%，p<0.001），透析率更高（4.9%对0.9%，p=0.023），射血分数更低（p=0.001），欧洲心脏手术风险评估系统（EuroSCORE）1更低（4.1对4.8，p=0.041），体外循环时间更长（100分钟对89分钟，p<0.001）。毛利人种族与30天死亡率独立相关，比值比（OR）为6.35，95%置信区间为1.01 - 39.9，p=0.046；手术并发症OR为2.05，1.04 - 4.04，p=0.040。在1.4±0.6年时，毛利人死亡率有升高趋势（风险比为2.91，0.92 - 9.20，p=0.069），1年死亡率为6.3%对1.5%。
尽管毛利人接受CABG手术时更年轻，但合并症更多，社会经济状况更差。毛利人的死亡率和并发症发生率更高。毛利人应更早获得CABG手术治疗。
