Department of Surgery, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand.
J Vasc Surg. 2022 Feb;75(2):455-463.e2. doi: 10.1016/j.jvs.2021.08.066. Epub 2021 Sep 24.
Disparities in cardiovascular disease according to socioeconomic factors and ethnicity are a global issue. The indigenous Māori population of New Zealand is not exempt. The aims of the present study were to assess whether ethnic disparities exist in the presentation and outcomes of acute aortic syndrome (AAS), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, in New Zealand.
A retrospective observational cohort study of consecutive AAS patients presenting to a tertiary referral center covering the Midland region of New Zealand (population, 816,900; 23.3% Māori) during a 10-year period was completed (2010-2020). Data were assessed by ethnicity (Māori vs non-Māori) and Stanford classification of AAS. The incidence of disease, 30-day mortality, and long-term all-cause and aortic-related mortality were recorded and assessed using logistic regression and Cox proportional hazards models.
A total of 250 patients had presented with AAS (Māori, 92 [36.8%]; type A, 144 [57.6%]). The age-standardized rates of AAS were higher in Māori than in non-Māori patients (6.9/100,000 person-years vs 2.0/100,000 person-years; risk ratio, 3.56; 95% confidence interval, 1.50-8.53; P = .002). Māori patients had presented at a younger age for both type A (age, 54.4 ± 12 years vs 66.0 ± 13.2 years; P < .001) and type B (age, 61.3 ± 10.2 years vs 68.8 ± 13.7 years; P = .005) AAS. Mortality at 30 days was higher for those with type A than for those with type B AAS (33.3% vs 13.2%; P < .001) but did not differ by ethnicity in our cohort. On multivariate analysis, no differences were found in 30-day or long-term survival when stratified by ethnicity.
The results from the present study have demonstrated that ethnic disparities in AAS exist in New Zealand, with Māori presenting at a younger age and with a greater incidence compared with other ethnicities. Whether this disparity is related to socioeconomic factors, access to preventive care, or other factors remains to be elucidated. Despite these differences in disease presentation, the survival outcomes when stratified by ethnicity were comparable in the present cohort.
根据社会经济因素和种族的心血管疾病差异是一个全球性问题。新西兰的土著毛利人也不例外。本研究的目的是评估在新西兰，急性主动脉综合征（AAS）的表现和结局是否存在种族差异，包括主动脉夹层、壁内血肿和穿透性主动脉溃疡。
对 2010 年至 2020 年期间在新西兰米德兰地区（人口 816900 人，毛利人占 23.3%）三级转诊中心连续就诊的 AAS 患者进行了回顾性观察队列研究。根据种族（毛利人与非毛利人）和 AAS 的斯坦福分类评估数据。记录疾病的发病率、30 天死亡率以及长期全因和主动脉相关死亡率，并使用逻辑回归和 Cox 比例风险模型进行评估。
共有 250 例患者患有 AAS（毛利人 92 例[36.8%]；A型 144 例[57.6%]）。与非毛利人患者相比，毛利人 AAS 的年龄标准化发病率更高（6.9/100000 人年比 2.0/100000 人年；风险比，3.56；95%置信区间，1.50-8.53；P=0.002）。无论是 A 型还是 B 型 AAS，毛利人患者的发病年龄都更小（年龄：A 型为 54.4±12 岁比 66.0±13.2 岁；P<0.001；B 型为 61.3±10.2 岁比 68.8±13.7 岁；P=0.005）。30 天死亡率在 A 型 AAS 患者中高于 B 型（33.3%比 13.2%；P<0.001），但在本队列中，不同种族之间的死亡率并无差异。多变量分析显示，按种族分层时，30 天或长期生存率无差异。
本研究结果表明，新西兰的 AAS 存在种族差异，毛利人比其他种族的发病年龄更小，发病率更高。这种差异是否与社会经济因素、预防保健的可及性或其他因素有关，仍有待阐明。尽管在疾病表现上存在差异，但本队列按种族分层后的生存结果是可比的。
