Chien Ching-Wen, Wang Cheng-Hua, Chao Zi-Hao, Huang Song-Kong, Chen Pei-En, Tung Tao-Hsin
Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China.
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei.
Medicine (Baltimore). 2019 Jan;98(2):e13883. doi: 10.1097/MD.0000000000013883.
To investigate relevant factors and patients with acute myocardial infarction (AMI) were admitted during between weekdays and weekends period.Retrospective population-based study setting: from the 2005 population-based national health insurance underwriting database of millions of people, random sampling (National Health Insurance Research Database [NHIRD]-Longitudinal Health Insurance Database [LHID] 2005).In 2000 to 2009 data of NHIRD, subjects presented with first episode AMI who had received the thrombolytic therapy (TPA), or percutaneous coronary artery intervention (PTCA) or coronary artery bypass graft (CABG) during between weekdays and weekends period.From 2000 to 2009 among patients with first AMI total of 2007 people, the weekday group 1453 people, the weekend group 554. The total mortality within 1 year showed 33.53%, the first-day mortality occupied 8.07% in 1 year of total mortality, increased mortality after admission 3 months later. Cox regression analysis showed that AMI has presented significant risk of death, there are 4 items: weekends, age, Charlson comorbidity index (CCI), thrombolytic therapy; in the other variables including emergency, hospital level, hospital ownership, and urban-rural gap are not significant differences. Further using hierarchical logistic regression analysis for Stratification of AMI mortality risk, it has significant that showed the hospital level, age, CCI, thrombolytic therapy; but emergency, PTCA and 3 CABG treatment are not significant differences.It was approved by the hierarchical logistic regression analysis after stratified correction that the present study will have a direct impact on weekdays and weekends death in the hospital level. It will also affect the individual level.
为调查相关因素,纳入在工作日和周末期间入院的急性心肌梗死(AMI)患者。基于人群的回顾性研究设定:从2005年基于人群的数百万国民健康保险承保数据库中随机抽样(国民健康保险研究数据库[NHIRD]-纵向健康保险数据库[LHID]2005)。在NHIRD 2000年至2009年的数据中,选取在工作日和周末期间首次发生AMI且接受过溶栓治疗(TPA)、经皮冠状动脉介入治疗(PTCA)或冠状动脉旁路移植术(CABG)的患者。2000年至2009年期间,首次发生AMI的患者共有2007人,工作日组1453人,周末组554人。1年内总死亡率为33.53%,1年内首日死亡率占总死亡率的8.07%,入院3个月后死亡率增加。Cox回归分析显示,AMI存在显著死亡风险的因素有4项:周末、年龄、Charlson合并症指数(CCI)、溶栓治疗;而其他变量包括急诊情况、医院级别、医院所有制以及城乡差距均无显著差异。进一步采用分层逻辑回归分析对AMI死亡风险进行分层,结果显示医院级别、年龄、CCI、溶栓治疗有显著意义;但急诊情况、PTCA和3种CABG治疗无显著差异。经分层校正后的分层逻辑回归分析证实,本研究中工作日和周末的死亡情况在医院级别上有直接影响,在个体层面也有影响。