Smith Ben, Haimona Mairarangi, Woon Kelvin
J Clin Neurosci. 2022 Dec;106:194-198. doi: 10.1016/j.jocn.2022.10.020. Epub 2022 Nov 3.
A retrospective analysis of 358 patients admitted to the neurosurgical unit at a tertiary referral centre in Aotearoa New Zealand between 2010 and 2017 was undertaken to describe the relationship of ethnicity to demographic, disease characteristic and outcome data in Māori and European New Zealanders experiencing aneurysmal subarachnoid haemorrhage (aSAH). Māori had a higher incidence (RR 1.38, p = 0.01; 95 % CI 1.08-1.77) and presented at a younger age (mean age difference of 5 years). Higher rates of smoking and hypertension were observed in the Māori population studied. However, these do not fully explain any other differences observed. There was no significant difference in clinical grade at presentation. However, despite experiencing lower rates of posterior circulation aneurysms (adjusted OR 0.33, p = 0.05) and radiological findings predicting highest risk of vasospasm i.e., Modified Rankin Scale 4 (OR 0.54, p = 0.02), Māori had a higher incidence of clinical vasospasm (adjusted OR 1.40, p = 0.048, 95 % CI 1.01-1.98). While there was no observed difference in mortality, Māori may experience lower rates of excellent neurological recovery and survive with greater disability compared to European New Zealanders. Overall, this study is suggestive of inequities between Māori and European New Zealanders and highlights the need for further investigation in this area.
对2010年至2017年间在新西兰奥塔哥一家三级转诊中心神经外科病房收治的358例患者进行了回顾性分析，以描述毛利人和欧洲裔新西兰人在发生动脉瘤性蛛网膜下腔出血（aSAH）时，种族与人口统计学、疾病特征及预后数据之间的关系。毛利人的发病率较高（相对危险度1.38，p = 0.01；95%置信区间1.08 - 1.77），且发病年龄较轻（平均年龄差5岁）。在所研究的毛利人群中，吸烟和高血压的发生率较高。然而，这些并不能完全解释所观察到的其他差异。就诊时的临床分级没有显著差异。然而，尽管毛利人后循环动脉瘤的发生率较低（校正比值比0.33，p = 0.05），且放射学检查结果显示血管痉挛风险最高即改良Rankin量表评分为4分的情况较少（比值比0.54，p = 0.02），但毛利人临床血管痉挛的发生率较高（校正比值比1.40，p = 0.048，95%置信区间1.01 - 1.98）。虽然未观察到死亡率的差异，但与欧洲裔新西兰人相比，毛利人可能神经功能恢复良好的比例较低，生存下来时残疾程度更高。总体而言，本研究提示毛利人和欧洲裔新西兰人之间存在不平等现象，并强调了该领域进一步研究的必要性。
