Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Heart. 2021 Dec;107(24):1946-1955. doi: 10.1136/heartjnl-2020-318650. Epub 2021 Apr 1.
This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC).
The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke.
Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and 'other' race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of 'other' race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles.
In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.
本研究旨在探讨种族/民族和社会经济地位对左心耳封堵术（LAAC）后院内并发症发生率的影响。
本研究使用美国国家住院患者样本，确定了 2015 年 10 月 1 日至 2018 年 12 月 31 日期间 LAAC 住院治疗的患者。这些患者按种族/民族和中位数邻里收入四分位数分层。主要结局是院内主要不良事件的发生，定义为术后出血、心脏和血管并发症、急性肾损伤和缺血性卒中的复合结局。
在 6478 例未经加权的 LAAC 住院患者中，58%为男性，黑种人、西班牙裔和“其他”种族/民族的患者各占队列的约 5%。按老年人人口进行校正后，白人个体 LAAC 手术的估计数量为 69.2/100000，而黑人个体为 29.5/100000，西班牙裔个体为 47.2/100000，“其他”种族/民族个体为 40.7/100000。黑种人患者的年龄约小 5 岁，但合并症负担更高。主要结局发生在 5%的患者中，不同种族/民族之间差异显著（p<0.001），但与邻里收入四分位组之间无差异（p=0.88）。经多水平模型校正后，黑种人患者院内主要不良事件的总体发生率高于白人（OR：1.60，95%CI 1.22 至 2.10，p<0.001）；然而，西班牙裔患者的急性肾损伤发生率更高（OR：2.19，95%CI 1.52 至 3.17，p<0.001）。收入四分位组之间调整后的总体院内并发症发生率无显著差异。
在本研究中，我们评估了 LAAC 患者中种族/民族差异，发现少数民族代表性不足，尤其是黑种人患者。与白人相比，黑种人患者合并症负担更高，院内并发症发生率更高。较低的社会经济地位与并发症发生率无关。
