Department of Medicine, Johns Hopkins School of Medicine, 9700 Skyhill Way Apt 307, Rockville, MD, USA.
Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
J Racial Ethn Health Disparities. 2019 Apr;6(2):345-355. doi: 10.1007/s40615-018-0530-x. Epub 2018 Sep 27.
The aim of this study is to examine how health outcomes varied by treatment selection and race/ethnicity among hospitalized US patients with ruptured or unruptured IAs.
A retrospective cohort study was conducted using a sample of 62,224 hospital discharges from the 2002-2012 Nationwide Inpatient Sample. Logistic regression models evaluated treatment selection as predictor of in-hospital survival (IHS: "yes," "no") and length of stay (LOS ≤ 7 days, > 7 days), overall and across racial/ethnic groups, taking hospital- and patient-level confounders into account, while stratifying by IA rupture status.
Compared to surgical clipping, endovascular coiling was associated with better IHS, after controlling for confounders. Compared to surgical clipping, LOS ≤ 7 days was less likely in patients with combination of treatments and more likely among patients with endovascular coiling as well as balloon- or stent-assisted coiling. Observed relationships varied significantly by race and ethnicity for IHS, but not for LOS ≤ 7 days. Whereas combination of treatments were associated with worse IHS than surgical clipping among Blacks alone, endovascular coiling was associated with better IHS than surgical clipping among White and Other racial/ethnic subgroups. These relationships were for the most part consistent among patients with and without IA rupture.
Racial and ethnic subgroups of IA patients experienced differential IHS by treatment selection, irrespective of IA rupture status. Prospective cohort studies are needed to further elucidate these racial and ethnic disparities, while collecting data on IA size, location, and morphology as well as Hunt and Hess grade for ruptured IA.
本研究旨在考察美国住院的破裂或未破裂颅内动脉瘤（IA）患者的治疗选择和种族/民族差异对健康结局的影响。
本研究采用 2002-2012 年全国住院患者样本中的 62224 例住院患者的回顾性队列研究。使用逻辑回归模型评估治疗选择作为住院生存（IHS：“是”、“否”）和住院时间（LOS≤7 天、>7 天）的预测因子，考虑到医院和患者层面的混杂因素，并根据 IA 破裂状态进行分层，总体上和按种族/民族群体进行分层。
与手术夹闭相比，血管内栓塞与更好的 IHS 相关，在控制混杂因素后。与手术夹闭相比，联合治疗的患者 LOS≤7 天的可能性较小，而血管内栓塞以及球囊或支架辅助栓塞的患者则更有可能。观察到的关系在 IHS 方面因种族和民族而有显著差异，但在 LOS≤7 天方面则没有。虽然联合治疗与手术夹闭相比，黑人患者的 IHS 更差，但与手术夹闭相比，白人患者和其他种族/民族亚组的血管内栓塞与更好的 IHS 相关。这些关系在有或没有 IA 破裂的患者中基本一致。
IA 患者的不同种族和民族亚组在治疗选择方面经历了不同的 IHS，而与 IA 破裂状态无关。需要前瞻性队列研究进一步阐明这些种族和民族差异，同时收集 IA 大小、位置和形态以及破裂性 IA 的 Hunt 和 Hess 分级的数据。
