Wu Jia-Rong, Lennie Terry A, Moser Debra K
1 University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA.
2 University of Kentucky College of Nursing, Lexington, KY, USA.
Eur J Cardiovasc Nurs. 2017 Jan;16(1):70-78. doi: 10.1177/1474515116641296. Epub 2016 Jul 7.
Health disparities are related to race/ethnicity, financial status and poor self-care behaviors, but the relationships between these factors remain unknown.
To explore the relationships between race/ethnicity, financial status and cardiac event-free survival, and the reasons for any disparities in patients with heart failure (HF).
We collected demographic data (e.g., race/ethnicity and financial status), clinical data (e.g., medication regimen) and self-care behaviors (by the Self-Care of Heart Failure Index) in 173 HF patients at baseline. Patients were grouped by race/ethnicity (African-American and Caucasian) and financial status (higher if they reported having "enough or more than enough to make ends meet" and lower if they "did not have enough to make ends meet"). Chi-square tests, t-tests and survival analyses were used to explore the relationships between race/ethnicity, financial status, self-care and survival.
African-American race/ethnicity and poor financial status were associated with poor outcomes ( p < 0.005) when controlling for covariates. HF patients with lower financial status reported engaging in fewer self-care maintenance behaviors than those with higher financial status. African-American HF patients trended to report engaging in fewer self-care maintenance behaviors than Caucasian HF patients. African-Americans with lower financial status had a four- to six-times higher risk of experiencing cardiac events compared to patients who were Caucasian with higher financial status before and after controlling for covariates.
African-American HF patients and those with lower financial status had worse outcomes and reported fewer self-care maintenance behaviors. Interventions promoting self-care may decrease the disparity in outcomes and should be tailored to African-Americans and those with lower financial status.
健康差异与种族/民族、经济状况和不良自我护理行为有关，但这些因素之间的关系尚不清楚。
探讨种族/民族、经济状况与无心脏事件生存期之间的关系，以及心力衰竭（HF）患者出现任何差异的原因。
我们在基线时收集了173例HF患者的人口统计学数据（如种族/民族和经济状况）、临床数据（如药物治疗方案）和自我护理行为（通过心力衰竭自我护理指数）。患者按种族/民族（非裔美国人和白种人）和经济状况分组（如果报告“有足够或超过足够的钱维持生计”则为较高经济状况，如果“没有足够的钱维持生计”则为较低经济状况）。使用卡方检验、t检验和生存分析来探讨种族/民族、经济状况、自我护理和生存之间的关系。
在控制协变量时，非裔美国人种族/民族和经济状况差与不良结局相关（p < 0.005）。经济状况较低的HF患者报告的自我护理维持行为比经济状况较高的患者少。非裔美国HF患者报告的自我护理维持行为比白种人HF患者少。在控制协变量前后，经济状况较低的非裔美国人发生心脏事件的风险是经济状况较高的白种人患者的四至六倍。
非裔美国HF患者和经济状况较低的患者结局较差，且报告的自我护理维持行为较少。促进自我护理的干预措施可能会减少结局差异，并且应该针对非裔美国人和经济状况较低的人群进行调整。
