Gusmano Michael K, Weisz Daniel, Allende Catherine, Rodwin Victor G
Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey.
Department of Research, The Hastings Center, Garrison, New York.
Health Equity. 2019 Aug 28;3(1):458-463. doi: 10.1089/heq.2018.0073. eCollection 2019.
To quantify and compare citywide disparities in the performance of coronary revascularization procedures in New York residents diagnosed with ischemic heart disease (IHD) by the characteristics of the patients and their neighborhood of residence in 2000-2002 and 2011-2013. We identify the number of hospitalizations for patients with diagnoses of IHD and/or congestive heart failure (CHF) and the number of revascularization procedures performed on the population 45 years and older, relying on hospital administrative data for New York City, by area of residence, from the Statewide Planning and Research Cooperative System (SPARCS). We conduct multiple logistic regressions to analyze the factors associated with revascularization for hospitalized patients admitted with IHD and CHF over the two time periods. Despite any decline in population health status, both the age-adjusted rates of inpatient hospital discharges for acute myocardial infarction, for IHD and for CHF, decreased as did the rates of revascularization procedures. Racial and ethnic disparities were much smaller in the later period than those documented earlier. However, there were persistent gender, insurance status, and neighborhood-level disparities in the treatment of heart disease. With the declines in rates of heart disease, our findings point to the need for more clinical and population-based research to improve the understanding of why race/ethnicity, gender, insurance status, and neighborhood-level disparities persist in the treatment of heart disease.
通过患者特征及其2000 - 2002年和2011 - 2013年居住社区的情况，对纽约被诊断为缺血性心脏病（IHD）的居民进行冠状动脉血运重建手术的全市差异进行量化和比较。我们依靠纽约市全州规划与研究合作系统（SPARCS）按居住区域提供的医院管理数据，确定诊断为IHD和/或充血性心力衰竭（CHF）患者的住院次数以及对45岁及以上人群进行的血运重建手术次数。我们进行多项逻辑回归分析，以分析两个时间段内因IHD和CHF住院的患者进行血运重建相关的因素。尽管人口健康状况有所下降，但急性心肌梗死、IHD和CHF的年龄调整后住院出院率以及血运重建手术率均有所下降。后期种族和族裔差异比早期记录的要小得多。然而，在心脏病治疗方面，性别、保险状况和社区层面的差异仍然存在。随着心脏病发病率的下降，我们的研究结果表明需要更多基于临床和人群的研究，以更好地理解种族/族裔、性别、保险状况和社区层面差异在心脏病治疗中持续存在的原因。
