Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Am J Cardiol. 2021 Jun 1;148:151-156. doi: 10.1016/j.amjcard.2021.02.039. Epub 2021 Mar 3.
Racial disparities in health outcomes have been widely documented in medicine, including in cardiovascular care. While some progress has been made, these disparities have continued to plague our healthcare system. Patients with cardiomyopathy are at an increased risk of death and cardiovascular hospitalizations. In the present analysis, we examined the baseline characteristics and outcomes of black and white men and women with cardiomyopathy. All patients with cardiomyopathy (left ventricular ejection fraction (LVEF) < 50%) cared for at University of Pittsburgh Medical Center (UPMC) between 2011 and 2017 were included in this analysis. Patients were stratified by race, and outcomes were compared between Black and White patients using Cox proportional hazard models. Of a total of 18,003 cardiomyopathy patients, 15,804 were white (88%), 1,824 were black (10%) and 375 identified as other (2%). Over a median follow-up time of 3.4 years, 7,899 patients died. Black patients were on average a decade younger (p <0.001) and demonstrated lower unadjusted all-cause mortality (hazard ratio [HR]: 0.83%; 95% CI 0.77 to 0.90; p < 0.001). However, after adjusting for age and other comorbidities, black patients had higher all-cause mortality compared to white patients (HR: 1.15, 95% CI 1.07 to 1.25; p < 0.001). These differences were seen in both men (HR:1.19, 95% CI 1.08 to 1.33; p < 0.001) and women (HR:1.12, 95% CI 0.99 to 1.25; p = 0.065). In conclusion, our data demonstrate higher all-cause mortality in black compared to white men and women with cardiomyopathy. These findings are likely explained, at least in part, by significantly higher rates of comorbidities in black patients. Earlier interventions targeting these comorbidities may mitigate the risk of progression to heart failure and improve outcomes.
在医学领域，包括心血管护理在内，健康结果的种族差异已经得到广泛记录。尽管已经取得了一些进展，但这些差异仍然困扰着我们的医疗保健系统。患有心肌病的患者死亡和心血管住院的风险增加。在本分析中，我们检查了黑人、白人和女性心肌病患者的基线特征和结局。在 2011 年至 2017 年间，匹兹堡大学医学中心（UPMC）治疗的所有心肌病患者（左心室射血分数（LVEF）<50%）均包括在本分析中。根据种族对患者进行分层，并使用 Cox 比例风险模型比较黑人患者和白人患者的结局。在总共 18003 名心肌病患者中，15804 名患者为白人（88%），1824 名患者为黑人（10%），375 名患者为其他（2%）。在中位数为 3.4 年的随访期间，7899 名患者死亡。黑人患者平均年轻十岁（p<0.001），未经调整的全因死亡率较低（风险比[HR]：0.83%；95%CI 0.77 至 0.90；p<0.001）。然而，在调整年龄和其他合并症后，与白人患者相比，黑人患者的全因死亡率更高（HR：1.15，95%CI 1.07 至 1.25；p<0.001）。这些差异在男性（HR：1.19，95%CI 1.08 至 1.33；p<0.001）和女性（HR：1.12，95%CI 0.99 至 1.25；p=0.065）中均可见。总之，我们的数据表明，与白人男性和女性心肌病患者相比，黑人的全因死亡率更高。这些发现可能至少部分解释为黑人患者合并症发生率明显更高。针对这些合并症的早期干预措施可能会降低进展为心力衰竭的风险并改善结局。
