黑人男性心脏病发作 30 天后的医疗保健系统隶属关系与再入院情况。

Health System Affiliation and 30-Day Readmission After Heart Attack in Black Men.

机构信息

Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.

Department of Urology, University of Minnesota, Minneapolis, Minnesota.

出版信息

Am J Prev Med. 2018 Nov;55(5 Suppl 1):S22-S30. doi: 10.1016/j.amepre.2018.05.021.

DOI:10.1016/j.amepre.2018.05.021

PMID:30670198

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6345181/

Abstract

INTRODUCTION

Black patients who experience acute myocardial infarction and receive care in high minority-serving hospitals have higher readmission rates. This study explores how hospital system affiliation (centralized versus decentralized/independent) impacts 30-day readmissions after acute myocardial infarction in black men.

METHODS

In 2018, the Healthcare Cost and Utilization Project State Inpatient Database (2009-2013) was used to observe 30-day readmission for acute myocardial infarction by race, and data from the American Hospital Association Annual Survey of Hospitals (2009-2013) to determine hospital system affiliation for the states Arizona, California, North Carolina, and Wisconsin. A series of hierarchic logistic regressions were conducted to determine if hospital system affiliation mediates the relationship between race and 30-day readmission.

RESULTS

Of 63,743 hospitalizations for acute myocardial infarction among men between 2009 and 2013, black men accounted for 7.1% of hospitalizations and 8.0% of readmissions. In both models, race significantly predicted 30-day readmission (unadjusted OR=1.25, 95% CI=1.14, 1.37, p<0.001; AOR=1.13, 95% CI=1.03, 1.25, p=0.046). After controlling for system type, black men were more likely to be readmitted after acute myocardial infarction than white men in both models (unadjusted OR=1.25, 95% CI=1.14, 1.38, p<0.001; AOR=1.14, 95% CI=1.03, 1.25). There was no difference in odds of being readmitted by race and hospital system type (unadjusted OR=0.88, 95% CI=0.25, 3.07, p=0.84, AOR=1.02, 95% CI=0.21, 5.10, p=0.98).

CONCLUSIONS

Black men appear to be more likely to be readmitted after acute myocardial infarction. Centralization does not appear to mediate the relationship between race and 30-day readmissions for acute myocardial infarction.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

摘要

介绍

在经历急性心肌梗死并在少数民族服务医院接受治疗的黑人患者中，再入院率较高。本研究探讨了医院系统隶属关系（集中与分散/独立）如何影响黑人男性急性心肌梗死后 30 天的再入院率。

方法

2018 年，使用医疗保健成本和利用项目州住院患者数据库（2009-2013 年）观察种族对急性心肌梗死 30 天再入院的影响，并使用美国医院协会年度医院调查数据（2009-2013 年）确定亚利桑那州、加利福尼亚州、北卡罗来纳州和威斯康星州的医院系统隶属关系。进行了一系列层次逻辑回归，以确定医院系统隶属关系是否在种族与 30 天再入院率之间起中介作用。

结果

在 2009 年至 2013 年间，男性急性心肌梗死住院患者中，黑人男性占住院患者的 7.1%，占再入院患者的 8.0%。在两个模型中，种族均显著预测 30 天再入院率（未调整的 OR=1.25，95%CI=1.14，1.37，p<0.001；AOR=1.13，95%CI=1.03，1.25，p=0.046）。在控制了系统类型后，在两个模型中，黑人男性在急性心肌梗死后再次入院的可能性均高于白人男性（未调整的 OR=1.25，95%CI=1.14，1.38，p<0.001；AOR=1.14，95%CI=1.03，1.25）。种族和医院系统类型对再次入院的可能性没有差异（未调整的 OR=0.88，95%CI=0.25，3.07，p=0.84，AOR=1.02，95%CI=0.21，5.10，p=0.98）。