Xian Ying, Holloway Robert G, Smith Eric E, Schwamm Lee H, Reeves Mathew J, Bhatt Deepak L, Schulte Phillip J, Cox Margueritte, Olson DaiWai M, Hernandez Adrian F, Lytle Barbara L, Anstrom Kevin J, Fonarow Gregg C, Peterson Eric D
From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
Stroke. 2014 Nov;45(11):3243-50. doi: 10.1161/STROKEAHA.114.005620. Epub 2014 Sep 11.
Although racial/ethnic differences in care are pervasive in many areas of medicine, little is known whether intracerebral hemorrhage (ICH) care processes or outcomes differ by race/ethnicity.
We analyzed 123 623 patients with ICH (83 216 white, 22 147 black, 10 519 Hispanic, and 7741 Asian) hospitalized at 1199 Get With The Guidelines-Stroke hospitals between 2003 and 2012. Multivariable logistic regression with generalized estimating equation was used to evaluate the association among race, stroke performance measures, and in-hospital outcomes.
Relative to white patients, black, Hispanic, and Asian patients were significantly younger, but more frequently had more severe stroke (median National Institutes of Health Stroke Scale, 9, 10, 10, and 11, respectively; P<0.001). After adjustment for both patient and hospital-level characteristics, black patients were more likely to receive deep venous thrombosis prophylaxis, rehabilitation assessment, dysphagia screening, and stroke education, but less likely to have door to computed tomographic time ≤25 minutes and smoking cessation counseling than whites. Both Hispanic and Asian patients had higher odds of dysphagia screening but lower odds of smoking cessation counseling. In-hospital all-cause mortality was lower for blacks (23.0%), Hispanics (22.8%), and Asians (25.3%) than for white patients (27.6%). After risk adjustment, all minority groups had lower odds of death, of receiving comfort measures only or of being discharged to hospice. In contrast, they were more likely to exceed the median length of stay when compared with white patients.
Although individual quality indicators in ICH varied by race/ethnicity, black, Hispanic, and Asian patients with ICH had lower risk-adjusted in-hospital mortality than white patients with ICH.
尽管医疗保健方面的种族/族裔差异在医学的许多领域普遍存在，但关于脑出血（ICH）的护理过程或结果是否因种族/族裔而异，人们知之甚少。
我们分析了2003年至2012年间在1199家参与“遵循卒中指南”项目的医院住院的123623例脑出血患者（83216例白人、22147例黑人、10519例西班牙裔和7741例亚裔）。采用广义估计方程的多变量逻辑回归来评估种族、卒中性能指标和住院结局之间的关联。
与白人患者相比，黑人、西班牙裔和亚裔患者明显更年轻，但卒中更严重的情况更为常见（美国国立卫生研究院卒中量表中位数分别为9、10、10和11；P<0.001）。在对患者和医院层面的特征进行调整后，黑人患者更有可能接受深静脉血栓形成预防、康复评估、吞咽困难筛查和卒中教育，但与白人相比，其从入院到进行计算机断层扫描的时间≤25分钟以及接受戒烟咨询的可能性较小。西班牙裔和亚裔患者进行吞咽困难筛查的几率较高，但接受戒烟咨询的几率较低。黑人（23.0%）、西班牙裔（22.8%）和亚裔（25.3%）患者的住院全因死亡率低于白人患者（27.6%）。经过风险调整后，所有少数族裔死亡、仅接受舒适护理措施或出院至临终关怀机构的几率均较低。相比之下，与白人患者相比，他们更有可能超过住院时间中位数。
尽管脑出血的个体质量指标因种族/族裔而异，但脑出血的黑人、西班牙裔和亚裔患者经风险调整后的住院死亡率低于脑出血的白人患者。
