按性别和种族/族裔划分的心力衰竭住院趋势的国家差异。
National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity.
作者信息
Ziaeian Boback, Kominski Gerald F, Ong Michael K, Mays Vickie M, Brook Robert H, Fonarow Gregg C
机构信息
From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Jul;10(7). doi: 10.1161/CIRCOUTCOMES.116.003552.
BACKGROUND
National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities.
METHODS AND RESULTS
The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100 000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% ( trend=0.002) between 2002 and 2013. Black men had a rate that was 229% ( trend=0.141) and black women, 240% ( trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% ( trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater ( trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% ( trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% ( trend=0.021) lower in 2013 relative to whites.
CONCLUSIONS
National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed.
背景
国家心力衰竭（HF）住院率尚未根据性别或种族/民族进行适当的年龄标准化。按亚组报告医院利用趋势对于监测人群健康和制定消除差异的干预措施很重要。
方法和结果
使用国家住院样本（NIS）来估计2002年至2013年间按性别和种族/民族划分的HF住院的粗率和年龄标准化率。直接标准化用于将率按年龄标准化到2000年美国标准人群。报告了亚组之间的相对差异。2002年至2013年间，全国年龄调整后的HF住院率从每10万人526.86例降至364.66例，下降了30.8%。尽管所有亚组的住院人数都有所下降，但2002年至2013年间，男性与女性的年龄标准化率之比从高20%增加到高39%（趋势=0.002）。2013年，黑人男性的发病率比白人高229%（趋势= .141），黑人女性比白人高240%（趋势=0.725），2002年至2013年间无显著变化。2002年，西班牙裔男性的发病率比白人高32%，到2013年，这一差距缩小到比白人高4%（趋势=0.047）。对于西班牙裔女性，2002年的发病率比白人高55%，到2013年缩小到比白人高8%（趋势=0.004）。2002年，亚太岛民男性的发病率比白人低27%，到2013年改善到比白人低43%（趋势=0.040）。对于亚太岛民女性，2002年的住院率比白人低24%，到2013年改善到比白人低43%（趋势=0.021）。
结论
近十年来，全国HF住院率稳步下降。按性别和种族/民族划分的HF负担和医院利用方面的差异仍然存在。需要采取重大的人群健康干预措施来减轻黑人的HF住院负担。需要评估解释西班牙裔和亚太岛民HF住院率改善的因素。
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