一项美国急诊部的全国性研究：心力衰竭住院治疗中的种族差异。
A National Study of U.S. Emergency Departments: Racial Disparities in Hospitalizations for Heart Failure.
机构信息
Department of Emergency Medicine and Center for Healthcare Studies, Northwestern University, Chicago, Illinois.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
Am J Prev Med. 2018 Nov;55(5 Suppl 1):S31-S39. doi: 10.1016/j.amepre.2018.05.020.
INTRODUCTION
Racial disparities in heart failure hospitalizations are well documented. The majority of heart failure hospitalizations originate from emergency departments, but emergency department hospitalization patterns for heart failure and the factors that influence hospitalization are poorly understood. This gap in knowledge was examined using a nationally representative sample of emergency department visits for heart failure.
METHODS
National Hospital Ambulatory Medicare Care Survey data on 2001-2010 emergency department visits were analyzed in 2015-2017 to examine age-related racial differences in hospitalization patterns for heart failure, using multivariable modified Poisson regression models.
RESULTS
More than 12million adult visits for heart failure to U.S. emergency departments occurred from 2001 to 2010, with 23% of visits by blacks. Overall, 71% of visits resulted in hospitalization (57% to floor beds and 14% to intensive care units). Among floor admissions for higher clinical acuity visits, whites were more likely than blacks to be hospitalized. Whites with higher clinical acuity were more likely to be hospitalized than those with lower clinical acuity (71% vs 63%, p=0.005). This expected pattern was not observed in blacks, particularly those aged ≥65years, who were hospitalized in 71% of lower clinical acuity visits, but only 61% of higher acuity visits. Among adults aged ≥65years, there was a significant interaction between clinical acuity Xrace with regard to hospitalization (p=0.037).
CONCLUSIONS
These results suggest age and racial disparities in hospitalization rates for emergency department patients with heart failure. The reasons for these disparities in hospitalization are unclear. Further studies on emergency department hospitalization decisions, and the impact of emergency department clinical factors, may help clarify this finding.
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.
简介
心力衰竭住院的种族差异有充分的记录。大多数心力衰竭住院源于急诊科，但心力衰竭急诊住院模式及其影响住院的因素知之甚少。利用全国代表性的心力衰竭急诊就诊样本，考察了这一知识空白。
方法
2015-2017 年，分析了 2001-2010 年全国医院门诊医疗补助调查（National Hospital Ambulatory Medicare Care Survey）中有关急诊就诊的数据，使用多变量修正泊松回归模型，研究心力衰竭住院模式的年龄相关种族差异。
结果
2001 年至 2010 年，美国急诊科有超过 1200 万例心力衰竭成人就诊，其中黑人占 23%。总体而言，71%的就诊导致住院（57%为病房床位，14%为重症监护病房）。在较高临床严重程度的门诊就诊中，白人比黑人更有可能住院。白人中较高临床严重程度的患者比较低临床严重程度的患者更有可能住院（71%比 63%，p=0.005）。这种预期模式在黑人中并未观察到，特别是年龄≥65 岁的黑人，他们在较低临床严重程度的就诊中 71%被住院，而在较高临床严重程度的就诊中只有 61%被住院。在年龄≥65 岁的成年人中，临床严重程度与种族之间存在显著的交互作用（p=0.037）。
结论
这些结果表明，急诊科心力衰竭患者的住院率存在年龄和种族差异。导致这些住院率差异的原因尚不清楚。进一步研究急诊科住院决策以及急诊科临床因素的影响，可能有助于阐明这一发现。
补充信息
本文是国家卫生研究院赞助的题为“非裔美国男性健康：研究、实践和政策影响”的补充内容的一部分。
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