Departments of Medicine.
Pediatrics.
J Clin Gastroenterol. 2023 Aug 1;57(7):731-736. doi: 10.1097/MCG.0000000000001743.
We sought to determine whether race/ethnicity is associated with hospitalization outcomes among patients admitted with acute cholangitis.
Few studies have evaluated the association between race and outcomes in patients with acute cholangitis.
We analyzed United States hospitalizations from 2009 to 2018 using the Nationwide Inpatient Sample (NIS). We included patients 18 years old or above admitted with an ICD9/10 diagnosis of cholangitis. Race/ethnicity was categorized as White, Black, Hispanic, or Other. We used multivariable regression to determine the association between race/ethnicity and in-hospital outcomes of interest, including endoscopic retrograde cholangiopancreatography (ERCP), early ERCP (<48 h from admission), length of stay (LOS), and in-hospital mortality.
Of 116,889 hospitalizations for acute cholangitis, 70% identified as White, 10% identified as Black, 11% identified as Hispanic, and 9% identified as Other. The proportion of non-White patients increased over time. On multivariate analysis controlling for clinical and sociodemographic variables, compared with White patients, Black patients had higher in-hospital mortality (adjusted odds ratio: 1.4, 95% confidence interval: 1.2-1.6, P <0.001). Black patients were also less likely to undergo ERCP, more likely to undergo delayed ERCP, and had longer LOS ( P <0.001 for all).
In this contemporary cohort of hospitalized patients with cholangitis, Black race was independently associated with fewer and delayed ERCP procedures, longer LOS, and higher mortality rates. Future studies with more granular social determinants of health data should further explore the underlying reasons for these disparities to develop interventions aimed at reducing racial disparities in outcomes among patients with acute cholangitis.
我们旨在确定在因急性胆囊炎入院的患者中，种族/民族是否与住院结局相关。
很少有研究评估种族与急性胆囊炎患者结局之间的关系。
我们使用全国住院患者样本（NIS）分析了 2009 年至 2018 年美国的住院数据。我们纳入了年龄在 18 岁及以上，以 ICD9/10 诊断为胆囊炎的住院患者。种族/民族分为白人、黑人、西班牙裔或其他。我们使用多变量回归来确定种族/民族与住院期间感兴趣的结局（包括内镜逆行胰胆管造影术[ERCP]、早期 ERCP（入院后 48 小时内）、住院时间[LOS]和院内死亡率）之间的关联。
在 116889 例急性胆囊炎住院患者中，70%为白人，10%为黑人，11%为西班牙裔，9%为其他。非白人患者的比例随时间增加。在多变量分析中，控制了临床和社会人口统计学变量后，与白人患者相比，黑人患者的院内死亡率更高（调整后的优势比：1.4，95%置信区间：1.2-1.6，P <0.001）。黑人患者接受 ERCP 的可能性较低，接受延迟 ERCP 的可能性较高，住院时间较长（所有 P<0.001）。
在本当代急性胆囊炎住院患者队列中，黑人种族与较少和延迟的 ERCP 手术、更长的 LOS 和更高的死亡率独立相关。未来的研究应该进一步探讨这些差异的潜在原因，利用更细粒度的健康社会决定因素数据，制定旨在减少急性胆囊炎患者结局中种族差异的干预措施。
