Grey Corina, Jackson Rod, Wells Susan, Marshall Roger, Mehta Suneela, Kerr Andrew J
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Eur J Prev Cardiol. 2016 Nov;23(17):1823-1830. doi: 10.1177/2047487316657671. Epub 2016 Jun 27.
The aim of this study was to investigate ischaemic heart disease (IHD) case fatality in high-risk ethnic populations in New Zealand.
This is a national data-linkage study using anonymised hospitalisation and mortality data.
Linked individual patient data were used to identify 35-84-year-olds who experienced IHD events (acute IHD hospitalisations and/or deaths) in 2009-2010. Subjects were classified as: (i) hospitalised with IHD and alive at 28 days post-event; (ii) hospitalised with IHD and died within 28 days; (iii) hospitalised with a non-IHD diagnosis and died from IHD within 28 days; or (iv) died from IHD but not hospitalised. Multinomial logistic regression was used to estimate the proportion of people in each group, as well as overall 28-day case fatality, adjusted for ethnic differences in demographic and comorbidity profiles.
A total of 26,885 people experienced IHD events (11.3% Māori, 4.0% Pacific and 2.5% Indian); 3.3% of people died within 28 days of IHD hospitalisations, 5.1% died of IHD within 28 days of non-IHD hospitalisations and 13.0% died of IHD without any recent hospitalisation. Overall adjusted case fatality was 12.6% in Indian, 20.5% in European, 26.0% in Pacific and 27.6% in Māori people. Compared to Europeans, the adjusted odds of death were approximately 50% higher in Māori and Pacific people and 50% lower in Indians, regardless of whether they were hospitalised.
Major ethnic inequalities in IHD case fatality occur with and without associated hospitalisations. Improvements in both primary prevention and hospital care will be required to reduce inequalities.
本研究旨在调查新西兰高危族裔人群的缺血性心脏病（IHD）病死率。
这是一项利用匿名住院和死亡数据的全国性数据关联研究。
使用关联的个体患者数据来识别2009年至2010年期间经历IHD事件（急性IHD住院和/或死亡）的35至84岁人群。受试者被分类为：（i）因IHD住院且事件发生后28天存活；（ii）因IHD住院且在28天内死亡；（iii）因非IHD诊断住院且在28天内死于IHD；或（iv）死于IHD但未住院。使用多项逻辑回归来估计每组人群的比例以及总体28天病死率，并根据人口统计学和合并症特征的种族差异进行调整。
共有26,885人经历IHD事件（毛利人占11.3%，太平洋岛民占4.0%，印度人占2.5%）；3.3%的人在IHD住院后28天内死亡，5.1%的人在非IHD住院后28天内死于IHD，13.0%的人死于IHD但近期未住院。总体调整后的病死率在印度人为12.6%，欧洲人为20.5%，太平洋岛民为26.0%，毛利人为27.6%。与欧洲人相比，无论是否住院，毛利人和太平洋岛民的调整后死亡几率比欧洲人高约50%，而印度人的调整后死亡几率比欧洲人低50%。
无论是否伴有住院治疗，IHD病死率都存在重大种族不平等。需要在一级预防和医院护理方面都加以改善，以减少不平等现象。
