van Oeffelen Aloysia A M, Rittersma Saskia, Vaartjes Ilonca, Stronks Karien, Bots Michiel L, Agyemang Charles
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA, Utrecht, the Netherlands.
Department of Cardiology, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
PLoS One. 2015 Sep 14;10(9):e0136415. doi: 10.1371/journal.pone.0136415. eCollection 2015.
Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI) between first generation ethnic minority groups (henceforth, migrants) and ethnic Dutch.
All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands. Ethnic Dutch and migrants from Suriname (Hindustani Surinamese and non-Hindustani Surinamese), Morocco, and Turkey were included (n = 1,765). Multivariable Cox proportional hazards regression analyses were used to identify ethnic inequalities in revascularisation rate (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) after a STEMI event.
On average, 73.2% of STEMI events were followed by a revascularisation procedure. After adjustment for confounders (age, sex, degree of urbanization) no significant differences in revascularisation rate were found between the ethnic Dutch population and Hindustani Surinamese (HR: 1.04; 0.85-1.27), non-Hindustani Surinamese (HR: 0.98; 0.63-1.51), Moroccan (HR: 0.94; 0.77-1.14), and Turkish migrants (HR: 1.04; 0.88-1.24). Additional adjustment for comorbidity and neighborhood income did not change our findings.
Our study suggests no ethnic inequalities in revascularisation rate after a STEMI event. This finding is in agreement with the universally accessible health care system in the Netherlands.
此前,荷兰观察到首次急性心肌梗死后的预后存在种族不平等现象。这可能是由于少数族裔群体与荷兰族裔在血运重建率上存在差异。因此,我们调查了第一代少数族裔群体(以下简称移民)与荷兰族裔在ST段抬高型心肌梗死(STEMI)发生后的血运重建率不平等情况。
在Achmea健康数据库的一个子集中识别出2006年至2011年间所有的STEMI事件,该数据库记录了荷兰中部一家主要健康保险公司Achmea所承保人员的医疗护理情况。纳入了荷兰族裔以及来自苏里南(印度斯坦苏里南人和非印度斯坦苏里南人)、摩洛哥和土耳其的移民(n = 1765)。采用多变量Cox比例风险回归分析来确定STEMI事件后血运重建率(经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG))的种族不平等情况。
平均而言,73.2%的STEMI事件之后进行了血运重建手术。在对混杂因素(年龄、性别、城市化程度)进行调整后,荷兰族裔人群与印度斯坦苏里南人(风险比:1.04;0.85 - 1.27)、非印度斯坦苏里南人(风险比:0.98;0.63 - 1.51)、摩洛哥人(风险比:0.94;0.77 - 1.14)以及土耳其移民(风险比:1.04;0.88 - 1.24)之间的血运重建率未发现显著差异。对合并症和邻里收入进行额外调整并未改变我们的研究结果。
我们的研究表明STEMI事件后血运重建率不存在种族不平等现象。这一发现与荷兰普遍可及的医疗保健系统相一致。