退行性二尖瓣反流修复术后中期结局的社会经济差异。
Socioeconomic disparities in midterm outcomes after repair for degenerative mitral regurgitation.
机构信息
Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif.
Department of Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
出版信息
J Thorac Cardiovasc Surg. 2024 Sep;168(3):809-817.e20. doi: 10.1016/j.jtcvs.2023.05.045. Epub 2023 Jun 27.
OBJECTIVE
The influence of socioeconomic disparities on survival after mitral repair is poorly defined. We examined the association between socioeconomic disadvantage and midterm outcomes of repair in Medicare beneficiaries with degenerative mitral regurgitation.
METHODS
US Centers for Medicare and Medicaid Services data were used to identify 10,322 patients undergoing isolated first-time repair for degenerative mitral regurgitation between 2012 and 2019. Zip code-level socioeconomic disadvantage was dichotomized with the Distressed Communities Index, which incorporates education level, poverty, unemployment, housing security, median income, and business growth; those with Distressed Communities Index score ≥80 were classified as distressed. The primary outcome was survival, censored at 3 years. Secondary outcomes included cumulative incidences of heart failure readmission, mitral reintervention, and stroke.
RESULTS
Of the 10,322 patients undergoing degenerative mitral repair, 9.7% (n = 1003) came from distressed communities. Patients from distressed communities underwent surgery at lower volume centers (11 vs 16 cases/year) and traveled further for surgical care (40 vs 17 miles) (both P values < .001). At 3 years, unadjusted survival (85.4%; 95% CI, 82.9%-87.5% vs 89.7%; 95% CI, 89.0%-90.4%) and cumulative incidence of heart failure readmission (11.5%; 95% CI, 9.6%-13.7% vs 7.4%; 95% CI, 6.9%-8.0%) were worse in patients from distressed communities (all P values < .001), whereas mitral reintervention rates were similar (2.7%; 95% CI, 1.8%-4.0% vs 2.8%; 95% CI, 2.5%-3.2%; P = .75). After adjustment, community distress was independently associated with 3-year mortality (hazard ratio, 1.21; 95% CI, 1.01-1.46) and heart failure readmissions (hazard ratio, 1.28; 95% CI, 1.04-1.58).
CONCLUSIONS
Community-level socioeconomic distress is associated with worse outcomes in degenerative mitral repair among Medicare beneficiaries.
目的
社会经济地位的差异对二尖瓣修复后生存的影响尚不清楚。我们研究了医疗保险受益人群中退行性二尖瓣反流患者修复的中期结果与社会经济劣势之间的关系。
方法
美国医疗保险和医疗补助服务中心的数据用于确定 2012 年至 2019 年间 10322 例首次单独接受退行性二尖瓣反流修复的患者。邮政编码级别的社会经济劣势通过包含教育水平、贫困、失业、住房保障、中位数收入和商业增长的困境社区指数进行二分类；困境社区指数评分≥80 分者归类为困境社区。主要结局为生存，截止 3 年。次要结局包括心力衰竭再入院、二尖瓣再干预和中风的累积发生率。
结果
在接受退行性二尖瓣修复的 10322 例患者中，9.7%（n=1003）来自困境社区。来自困境社区的患者在手术量较低的中心接受手术（每年 11 例与 16 例），并且手术路程较远（40 英里与 17 英里）（均 P 值<.001）。在 3 年时，未调整的生存率（85.4%；95%置信区间，82.9%-87.5% vs 89.7%；95%置信区间，89.0%-90.4%）和心力衰竭再入院的累积发生率（11.5%；95%置信区间，9.6%-13.7% vs 7.4%；95%置信区间，6.9%-8.0%）在困境社区患者中更差（所有 P 值均<.001），而二尖瓣再干预率相似（2.7%；95%置信区间，1.8%-4.0% vs 2.8%；95%置信区间，2.5%-3.2%；P=0.75）。调整后，社区困境与 3 年死亡率（风险比，1.21；95%置信区间，1.01-1.46）和心力衰竭再入院（风险比，1.28；95%置信区间，1.04-1.58）独立相关。
结论
在医疗保险受益人群中，社区层面的社会经济困境与退行性二尖瓣修复的不良结局相关。
Zotero 插件