Mustapha J A, Fisher Bryan T, Rizzo John A, Chen Jie, Martinsen Brad J, Kotlarz Harry, Ryan Michael, Gunnarsson Candace
Metro Health University of Michigan Health, Wyoming, MI, USA.
Vascular and Endovascular Surgery, The Surgical Clinic, PLLC, Nashville, TN, USA.
J Racial Ethn Health Disparities. 2017 Feb 15;4(5):784-95. doi: 10.1007/s40615-016-0261-9.
While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors.
This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates.
Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis.
Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
虽然已有研究记录了外周动脉疾病（PAD）患者截肢率方面的种族和族裔差异，但具体因素的重要性尚未得到量化。本研究旨在提供此类证据，并量化差异中有多少反映了可观察到的因素与无法解释的因素。
本研究使用了具有全国代表性的2006年至2013年HCUP住院患者数据库，纳入主要诊断为PAD的白人、非裔美国人或西班牙裔患者。采用多变量逻辑回归模型来确定截肢率的决定因素。
多变量结果显示，非裔美国人和西班牙裔被截肢的可能性约为白人的两倍。模型中的观察因素共同解释了非裔美国人差异的51%至55%，以及西班牙裔差异的64%至69%。结果表明，非裔美国人和西班牙裔获得医疗服务的机会较少，因为他们在病情更严重且更可能是紧急情况下入院。
截肢率方面的种族和族裔差异很大，疾病严重程度和入院来源是关键因素。
