Kwan Gene F, Enserro Danielle M, Benjamin Emelia J, Walkey Allan J, Wiener Renda Soylemez, Magnani Jared W
Department of Medicine, Boston University School of Medicine, USA.
Department of Biostatistics, Boston University School of Public Health, USA.
Proclins Cardiol. 2018;1(1):1005. Epub 2018 Dec 14.
Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities.
In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospital. We accounted for case-mix and clustering by race within hospitals to estimate odds ratios (OR) for death associated with individual patient race and hospital racial composition. We identified 676,567 hospitalizations (mean age 71.8 years, 53.6% women) with principal diagnosis of AF (84.2% White, 7.1% Black, 5.0% Hispanic). Black (vs. White) race was associated with 1.63-fold (95% CI, 1.50-1.78) risk of death. Other races had similar risk of death as Whites. Risk of death for Blacks (vs. Whites) declined over time [2001: OR 1.78(95% CI 1.31-2.43); 2012: OR 1.23(95% CI 0.92-1.64)]. Racial differences in deaths within hospitals narrowed, while hospitals with larger proportions of Blacks had persistently worse outcomes than hospitals with fewer Blacks (OR 1.08 per 10% increase in Blacks in 2001 and 2012).
Black patients with a principal diagnosis of AF were more likely to suffer in-hospital death than Whites. Our findings suggest racial disparities based upon individual patients' race improved over time, but outcomes were persistently worse at hospitals with higher proportions of Black patients, regardless of patients' races.
了解心房颤动（AF）结局中的种族差异可能有助于指导干预措施以减少健康不平等现象。
在一项使用2001 - 2012年全国住院患者样本对以AF为主诊断住院的成年人进行的回顾性横断面研究中，我们评估了住院期间的种族差异。我们考虑了病例组合以及医院内按种族的聚类情况，以估计与个体患者种族和医院种族构成相关的死亡比值比（OR）。我们确定了676,567例以AF为主诊断的住院病例（平均年龄71.8岁，53.6%为女性）（84.2%为白人，7.1%为黑人，5.0%为西班牙裔）。黑人（与白人相比）种族与死亡风险高1.63倍（95%CI，1.50 - 1.78）相关。其他种族的死亡风险与白人相似。黑人（与白人相比）的死亡风险随时间下降[2001年：OR 1.78（95%CI 1.31 - 2.43）；2012年：OR 1.23（95%CI 0.92 - 1.64）]。医院内的种族死亡差异缩小，而黑人比例较高的医院的结局始终比黑人较少的医院更差（2001年和2012年黑人比例每增加10%，OR为1.08）。
以AF为主诊断的黑人患者比白人更易在住院期间死亡。我们的研究结果表明，基于个体患者种族的种族差异随时间有所改善，但在黑人患者比例较高的医院，无论患者种族如何，结局始终更差。
