创伤性损伤后非裔美国人和白种人的死亡率相同：来自国家数据的配对分析
African-American and Caucasian mortalities are the same after traumatic injury: pair matched analysis from a national data.
作者信息
Ahmed Nasim, Kountz David, Kuo Yenhong
机构信息
Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune City, New Jersey, USA.
Diversity and Equity, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
出版信息
Trauma Surg Acute Care Open. 2020 Mar 31;5(1):e000436. doi: 10.1136/tsaco-2019-000436. eCollection 2020.
BACKGROUND
African-Americans have worse outcomes than Caucasians in many clinical conditions studied, including trauma. We sought to analyze if mortality is different in these groups through analysis of a national data set.
METHODS
Recent data from the national Trauma Quality Improvement Program were assessed with analysis, including all African-American or Caucasian patients who were brought to level I or level II trauma centers for care. Propensity scores were calculated for each African-American patient using age, sex, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), injury type, insurance information and American College of Surgeons trauma level. The primary outcome of this study was in-hospital mortality, and the secondary outcomes were hospital length of stay and discharge disposition.
RESULTS
A total of 82 150 (13.65%) out of 601 768 patients who qualified for the inclusion in the study were African-American. The remaining 519 618 (86.35%) were Caucasian. The median age (IQR) of the patients was 54 (33 to 72) years old, and approximately two-thirds of the patients were male. The median ISS and GCS score were 12 (9 to 17) and 15 (15 to 15), respectively. More than 90% of patients sustained blunt injuries. Overall, there was no significant difference found in overall in-hospital mortality between Caucasians and African-American patients (3% vs. 2.9%, p=0.2); however, the median (95% CI) hospital length of stay was 1 day longer in African-American patients compared with Caucasian patients (5 (5.5) vs. 4 (4.4), p<0.001). When the discharged destinations between the two groups were compared, a higher proportion of Caucasians were discharged to home without services (66% vs. 33%).
CONCLUSION
Our study showed that trauma mortalites among African-American and Caucasians are the same. Efforts to mitigate the ethnic and racial biases in the delivery of healthcare should continue, and these results (no differences in mortality) should be validated in other clinical settings.
LEVEL OF EVIDENCE
Level II.
背景
在包括创伤在内的许多临床研究中，非裔美国人的治疗结果比白种人更差。我们试图通过分析全国数据集来分析这些群体的死亡率是否存在差异。
方法
对国家创伤质量改进计划的最新数据进行评估分析，纳入所有被送往一级或二级创伤中心接受治疗的非裔美国患者或白种人患者。使用年龄、性别、损伤严重程度评分（ISS）、格拉斯哥昏迷量表（GCS）、损伤类型、保险信息和美国外科医师学会创伤级别为每位非裔美国患者计算倾向得分。本研究的主要结局是住院死亡率，次要结局是住院时间和出院处置情况。
结果
在符合纳入研究标准的601768例患者中，共有82150例（13.65%）为非裔美国人。其余519618例（86.35%）为白种人。患者的中位年龄（四分位间距）为54岁（33至72岁），约三分之二的患者为男性。ISS和GCS评分的中位数分别为12（9至17）和15（15至15）。超过90%的患者为钝性损伤。总体而言，白种人和非裔美国患者的总体住院死亡率无显著差异（3%对2.9%，p = 0.2）；然而，非裔美国患者的中位（95%CI）住院时间比白种人患者长1天（5（5.5）对4（4.4），p < 0.001）。当比较两组的出院目的地时，更高比例的白种人出院后回家且无需服务（66%对33%）。
结论
我们的研究表明，非裔美国人和白种人的创伤死亡率相同。应继续努力减轻医疗保健提供过程中的种族偏见，这些结果（死亡率无差异）应在其他临床环境中得到验证。
证据级别
二级。
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