Zahuranec Darin B, Lisabeth Lynda D, Baek Jonggyu, Adelman Eric E, Garcia Nelda M, Case Erin C, Campbell Morgan S, Morgenstern Lewis B
Stroke Program, Department of Neurology, University of Michigan Medical School.
Department of Epidemiology, University of Michigan School of Public Health.
J Health Dispar Res Pract. 2017 Spring;10(1):111-123.
Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor. Two summary measure of overall quality were also created (binary measure of defect-free care and the proportion of measures achieved for which the patient was eligible). 757 individuals were included (480 MAs and 277 NHWs). MAs were younger, more likely to have hypertension and diabetes, and less likely to have atrial fibrillation than NHWs. MAs were less likely than NHWs to receive tPA (RR: 0.72, 95% confidence interval (CI) 0.52, 0.98), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge than NHWs (RR 0.73, 95% CI 0.58, 0.94). There were no ethnic differences in the other individual quality measures, or in the two summary measures assessing overall quality. In conclusion, there were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in the proportion of patients who received tPA and anticoagulant at discharge for atrial fibrillation.
墨西哥裔美国人（MAs）中风后的预后情况比非西班牙裔白人（NHWs）更差，但尚不清楚中风护理质量的种族差异是否会导致这些更差的预后。我们在基于人群的前瞻性科珀斯克里斯蒂脑卒中新发监测（BASIC）项目（2009年2月至2012年6月）中，调查了MA和NHW住院中风护理质量的种族差异。基于2008年联合委员会初级中风中心定义的住院中风护理质量指标，由一名经过培训的摘要员从病历中进行评估。还创建了两个总体质量的汇总指标（无缺陷护理的二元指标以及患者符合条件的指标达成比例）。共纳入757人（480名MA和277名NHW）。与NHW相比，MA更年轻，患高血压和糖尿病的可能性更大，患心房颤动的可能性更小。MA接受tPA治疗的可能性低于NHW（风险比：0.72，95%置信区间（CI）0.52，0.98），患有心房颤动的MA出院时接受抗凝药物治疗的可能性低于NHW（风险比0.73，95%CI 0.58，0.94）。在其他个体质量指标或评估总体质量的两个汇总指标方面，没有种族差异。总之，MA和NHW在中风护理的总体质量上没有种族差异，尽管在接受tPA治疗和心房颤动出院时接受抗凝治疗的患者比例上存在种族差异。
