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美国急性心肌梗死和 COVID-19 死亡率的种族差异:一项全国性分析。

Racial Disparities in Mortality Associated With Acute Myocardial Infarction and COVID-19 in the United States: A Nationwide Analysis.

机构信息

Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA.

Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.

出版信息

Curr Probl Cardiol. 2023 Sep;48(9):101798. doi: 10.1016/j.cpcardiol.2023.101798. Epub 2023 May 11.

Abstract

This study assessed the COVID-19 pandemic's impact on racial disparities in acute myocardial infarction (AMI) management and outcomes. We reviewed AMI patient management and outcomes in the pandemic's initial nine months, comparing COVID-19 and non-COVID-19 cases using 2020's National Inpatient Sample data. Our findings revealed that patients with concurrent AMI and COVID-19 had higher in-hospital mortality (aOR 3.19, 95% CI 2.63-3.88), increased mechanical ventilation (aOR 1.90, 95% CI 1.54-2.33), and higher initiation of hemodialysis (aOR 1.38, 95% CI 1.05-1.89) compared to those without COVID-19. Moreover, Black and Asian/Pacific Islander patients had higher in-hospital mortality than White patients, (aOR 2.13, 95% CI 1.35-3.59; aOR 3.41, 95% CI 1.5-8.37). Also, Black, Hispanic, and Asian/Pacific Islander patients showed higher odds of initiating hemodialysis (aOR 5.48, 95% CI 2.13-14.1; aOR 2.99, 95% CI 1.13-7.97; aOR 7.84, 95% CI 1.55-39.5), and were less likely to receive PCI for AMI (aOR 0.71, 95% CI 0.67-0.74; aOR 0.81, 95% CI 0.77-0.86; aOR 0.82, 95% CI 0.75-0.90). Black patients also showed less likelihood of undergoing CABG (aOR 0.55, 95% CI 0.49-0.61). Our study highlights elevated mortality and complications in COVID-19 AMI patients, emphasizing significant racial disparities. These findings underscore the pressing need for initiatives addressing healthcare disparities, enhancing access, and promoting culturally sensitive care to boost health equity.

摘要

本研究评估了 COVID-19 大流行对急性心肌梗死(AMI)管理和结局中种族差异的影响。我们回顾了大流行最初九个月的 AMI 患者管理和结局,使用 2020 年全国住院患者样本数据比较了 COVID-19 和非 COVID-19 病例。我们的研究结果表明,同时患有 AMI 和 COVID-19 的患者住院死亡率更高(aOR 3.19,95%CI 2.63-3.88),机械通气的使用更多(aOR 1.90,95%CI 1.54-2.33),开始血液透析的比例更高(aOR 1.38,95%CI 1.05-1.89),与没有 COVID-19 的患者相比。此外,与白人患者相比,黑人患者和亚太裔患者的住院死亡率更高(aOR 2.13,95%CI 1.35-3.59;aOR 3.41,95%CI 1.5-8.37)。此外,黑人、西班牙裔和亚太裔患者开始血液透析的可能性更高(aOR 5.48,95%CI 2.13-14.1;aOR 2.99,95%CI 1.13-7.97;aOR 7.84,95%CI 1.55-39.5),接受 AMI 经皮冠状动脉介入治疗(PCI)的可能性更小(aOR 0.71,95%CI 0.67-0.74;aOR 0.81,95%CI 0.77-0.86;aOR 0.82,95%CI 0.75-0.90)。黑人患者行冠状动脉旁路移植术(CABG)的可能性也较小(aOR 0.55,95%CI 0.49-0.61)。我们的研究强调了 COVID-19 合并 AMI 患者死亡率和并发症升高,凸显了显著的种族差异。这些发现突显了需要采取举措解决医疗保健差异,增加获取途径,并促进文化敏感护理,以提高健康公平性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/967a/10174333/4c6867fe680a/gr1_lrg.jpg

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