种族、民族和保险状况与 PERT 治疗的急性肺栓塞患者结局的关联：一项回顾性观察研究。
Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study.
机构信息
Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA.
出版信息
Respir Res. 2024 Jun 24;25(1):259. doi: 10.1186/s12931-024-02872-5.
BACKGROUND
Management of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT.
METHODS
We performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes.
RESULTS
Median age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different.
CONCLUSION
Within a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.
背景
PE 管理已经通过实施 PE 反应团队（PERT）实现了流程化。种族、民族和保险状况已知会影响急性 PE 患者的结局。然而，PERT 为基础的护理是否减轻了这些种族和民族差异仍不清楚。我们的目的是评估种族、民族和保险状况与 PERT 管理的急性 PE 患者结局之间的关联。
方法
我们对 2021 年 1 月至 2023 年 10 月期间在西奈山卫生系统（纽约州纽约市）的三家城市教学医院之一就诊的 290 例急性 PE 患者进行了回顾性图表审查。进行了倾向评分加权分析，以探讨种族、民族和保险状况与总体结局的关联。
结果
纳入患者的中位年龄为 65.5 岁，其中 149 例（51.4%）为女性。白人、黑人、亚裔患者分别占队列的 56.2%（163 例）、39.6%（115 例）和 3.5%（10 例）。西班牙裔或拉丁裔患者占样本的 8.3%（24 例）。30 天死亡率、大出血和 30 天再入院率分别为 10.3%、2.1%和 12.8%。与白人患者相比，黑人患者大出血的可能性更高（优势比 [OR]：1.445；p<0.0001）。与非西班牙裔或拉丁裔患者相比，西班牙裔或拉丁裔患者接受导管直接溶栓治疗（OR：0.966；p=0.0003）和导管直接或手术取栓术（OR：0.906；p<0.0001）的可能性较低。与有保险的患者相比，未参保患者接受全身溶栓治疗（OR：1.034；p=0.0008）和导管直接溶栓治疗（OR：1.059；p<0.0001）的可能性更高，而接受导管直接或手术取栓术（OR：0.956；p=0.015）的可能性较低，但 30 天死亡率和 30 天大出血的可能性无显著差异。
结论
在接受 PERT 治疗的急性 PE 患者队列中，种族、民族与总体结局之间存在显著关联。西班牙裔或拉丁裔和无保险状况与接受导管直接或手术取栓术的可能性较低相关。这些结果表明，尽管对急性 PE 患者进行了 PERT 治疗，但仍存在与种族和保险状况相关的差异。
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