Tong Xin, Carlson Susan A, Kuklina Elena V, Coronado Fátima, Yang Quanhe, Merritt Robert K
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
JACC Adv. 2024 Sep 6;3(10):101258. doi: 10.1016/j.jacadv.2024.101258. eCollection 2024 Oct.
Inequities in stroke outcomes have existed for decades, and the COVID-19 pandemic amplified these inequities.
This study examined the association between social vulnerability and all-cause mortality among Medicare beneficiaries hospitalized with acute ischemic stroke (AIS) during COVID-19 pandemic periods.
We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS between April 1, 2020, and December 31, 2021 (followed until December 31, 2023) merged with county-level data from the 2020 Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's Social Vulnerability Index (SVI). We used a Cox proportional hazard model to examine the association between SVI quartile and all-cause mortality.
Among 176,123 Medicare fee-for-service beneficiaries with AIS, 29.9% resided in the most vulnerable counties (SVI quartile 4), while 14.9% resided in counties with least social vulnerability (SVI quartile 1). AIS Medicare beneficiaries living in the most vulnerable counties had the highest proportions of adults aged 65 to 74 years, non-Hispanic Black or Hispanic, severe stroke at admission, a history of COVID-19, and more prevalent comorbidities. Compared to those living in least vulnerable counties, AIS Medicare beneficiaries living in most vulnerable counties had significantly higher all-cause mortality (adjusted HR: 1.11, 95% CI: 1.08-1.14). The pattern of association was largely consistent in subgroup analyses by age group, sex, and race and ethnicity.
Higher social vulnerability levels were associated with increased all-cause mortality among AIS Medicare beneficiaries. To improve outcomes and address disparities, it may be important to focus efforts toward addressing social vulnerability.
中风结局的不平等现象已存在数十年，而新冠疫情加剧了这些不平等。
本研究探讨了新冠疫情期间因急性缺血性中风（AIS）住院的医疗保险受益人的社会脆弱性与全因死亡率之间的关联。
我们分析了2020年4月1日至2021年12月31日期间因AIS住院的年龄≥65岁的医疗保险按服务收费受益人的数据（随访至2023年12月31日），并与2020年疾病控制与预防中心/有毒物质和疾病登记处社会脆弱性指数（SVI）的县级数据合并。我们使用Cox比例风险模型来研究SVI四分位数与全因死亡率之间的关联。
在176,123名患有AIS的医疗保险按服务收费受益人中，29.9%居住在最脆弱的县（SVI四分位数4），而14.9%居住在社会脆弱性最低的县（SVI四分位数1）。居住在最脆弱县的AIS医疗保险受益人中，65至74岁的成年人、非西班牙裔黑人或西班牙裔、入院时严重中风、有新冠病史以及合并症更普遍的比例最高。与居住在最不脆弱县的人相比，居住在最脆弱县的AIS医疗保险受益人全因死亡率显著更高（调整后HR：1.11，95%CI：1.08 - 1.14）。在按年龄组、性别、种族和民族进行的亚组分析中，关联模式基本一致。
较高的社会脆弱性水平与AIS医疗保险受益人的全因死亡率增加有关。为了改善结局并解决差异问题，努力解决社会脆弱性可能很重要。
