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美国成年人高血压相关医院死亡率的种族差异

Racial Disparities in Hypertension-Related Hospital Mortality Among Adults in the United States.

作者信息

Noah Gideon U, Omohoro Mercy U, Magacha Hezborn M, Fuko Catherine D, Ezike Tobechukwu

机构信息

Internal Medicine, Center of Excellence in Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, USA.

Health Sciences, Kent State University Ohio, Kent, USA.

出版信息

Cureus. 2025 Mar 23;17(3):e81043. doi: 10.7759/cureus.81043. eCollection 2025 Mar.

Abstract

Background and objectives Hypertension has been known to be a significant contributor to hospital admissions and, consequently, high mortality rates across the globe and in the United States. Racial disparities, which entail the unequal treatment or outcomes experienced by different racial or ethnic groups, influenced by systemic inequality and/or discrimination, have been shown by other studies to have an impact on hypertension-related in-hospital mortality. These disparities may have influenced several factors that impact equal rights and access to healthcare across racial groups. For example, the poor implementation of health policies, poor access to care, and poor socioeconomic factors that highlight the presence of racial disparities may have a huge impact on hypertensive care. This research paper builds on existing knowledge and aims to further explore the legitimacy of the claim that racial disparities exist among different racial groups, particularly among adults in the United States, and that it plays a major role in causing in-hospital mortality. The data used for this study were drawn from the Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample (NIS) between 2016 and 2022. Methods Using the NIS database, we identified 360,642 individuals who were aged 18 years and older and were hospitalized for hypertension-related issues in a hospital within the United States. Descriptive, bivariate, and multivariate analyses were conducted to examine the relationship between race and in-hospital mortality. Potential confounders were adjusted for and included age, sex, location of hospital, insurance payer, and diabetes (as a comorbidity). Results In our study sample, 241,991 (67%) of the patients were White, 72,778 (20%) were Black, 29,464 (8%) were Hispanic, 6,564 (2%) were Asian/Pacific Islanders, 1,623 (1%) were Native Americans, and 8,187 (2%) were individuals from other races that were not included in the races mentioned above. For this study population, significant racial disparities in hypertensive in-hospital mortality were observed, with Black patients experiencing higher mortality rates (55%) compared to their White counterparts (OR=1.55, 95% CI=1.42,1.69, p<0.0001). Conclusion The findings of this study provide further evidence of racial disparities in hypertension-related hospital mortality, with Black individuals showing significantly higher odds of hospital mortality from hypertension. This study highlights the need to combat health inequities in hypertension outcomes through a targeted approach, which could include enhancing access to high-quality hypertensive care, provision of culturally sensitive care, and promotion of positive policies that can enhance these outcomes.

摘要

背景与目标

高血压一直被认为是导致全球和美国住院率上升以及死亡率居高不下的重要因素。其他研究表明,种族差异(即不同种族或族裔群体受到系统性不平等和/或歧视影响而经历的不平等治疗或结果)会对高血压相关的住院死亡率产生影响。这些差异可能影响了几个影响不同种族群体平等权利和医疗保健可及性的因素。例如,卫生政策执行不力、获得医疗服务的机会不佳以及突出种族差异存在的不良社会经济因素可能对高血压护理产生巨大影响。本研究论文基于现有知识,旨在进一步探讨不同种族群体(特别是美国成年人)之间存在种族差异这一说法的合理性,以及这种差异在导致住院死亡率方面所起的主要作用。本研究使用的数据来自2016年至2022年医疗保健成本与利用项目(HCUP)的全国住院患者样本(NIS)。

方法

使用NIS数据库,我们确定了360,642名年龄在18岁及以上、因高血压相关问题在美国医院住院的患者。进行了描述性、双变量和多变量分析,以检验种族与住院死亡率之间的关系。对潜在混杂因素进行了调整,包括年龄、性别、医院位置、保险支付方和糖尿病(作为合并症)。

结果

在我们的研究样本中,241,991名(67%)患者为白人,72,778名(20%)为黑人,29,464名(8%)为西班牙裔,6,564名(2%)为亚裔/太平洋岛民,1,623名(1%)为美国原住民,8,187名(2%)为上述种族未包括的其他种族个体。对于该研究人群,观察到高血压住院死亡率存在显著的种族差异,黑人患者的死亡率(55%)高于白人患者(OR = 1.55,95% CI = 1.42, 1.69,p < 0.0001)。

结论

本研究结果进一步证明了高血压相关住院死亡率存在种族差异,黑人个体因高血压导致住院死亡的几率显著更高。本研究强调需要通过有针对性的方法来消除高血压治疗结果方面的健康不平等,这可能包括增加获得高质量高血压护理的机会、提供具有文化敏感性的护理以及推广能够改善这些结果的积极政策。

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