Johnson Adedoyin, Knapp Shannon M, Mwansa Hunter, Bisonó Janina Quintero, Bolakale-Rufai Ikeoluwapo Kendra, Moore Wanda, Yankah Ekow, Yee Ryan, Trabue Dalancee, Williamson Francesca, Pool Natalie, Hebdon Megan, Capers Quinn, Blount Courtland, Kimbrough Nia, Johnson Denee, Evans Jalynn, Foree Brandi, Holman Rev Anastasia, Brown David, Edmonds Brownsyne Tucker, Nallamothu Brahmajee, Hollingsworth John, Breathett Khadijah
Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA.
Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA; Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA.
JACC Adv. 2025 Jul 18;4(8):101988. doi: 10.1016/j.jacadv.2025.101988.
The extent of structural racism in cardiovascular care is not well studied.
The purpose of this study was to determine whether hospital segregation index (SI) (degree of dissimilarity between teams caring for Black vs White patients) is associated with receipt of a cardiologist's care, readmission up to 30 days, and 1-year survival for Black vs White patients admitted with heart failure (HF) or ischemic heart disease (IHD).
Using Optum's Clinformatics Data Mart, we examined the effect of hospital SI on Black and White patients admitted with primary diagnoses of HF or IHD from 2010 to 2018 using mixed effects models. Hospitals were grouped by SI tertile.
Overall, 119,272 patients (29.4% Black, 70.6% White) with HF and 183,165 patients (17.9% Black and 82.1% White) with IHD were analyzed. Across SI tertiles, Black patients with HF had lower odds of receiving a cardiologist's care compared to White patients. Across SI tertiles and cardiology care, there was no difference in the hazard of readmission by race, and odds of 1-year survival were higher for Black patients. Among patients with IHD, there was no difference in odds of receiving cardiology care between races across SI tertiles. Black patients not seen by cardiologists had 20% higher hazard of readmission at high SI hospitals (HR: 1.20; 95% CI: 1.00-1.44). Odds of 1-year survival were higher for Black patients (OR: 1.10; 95% CI: 1.04-1.17) seen by cardiologists in low SI hospitals.
Among Black vs White patients, HF outcomes did not vary by SI tertiles. However, in IHD, SI impacted Black patients' risk of readmission and survival.
心血管护理中结构性种族主义的程度尚未得到充分研究。
本研究的目的是确定医院隔离指数（SI）（照顾黑人与白人患者的团队之间的差异程度）是否与心力衰竭（HF）或缺血性心脏病（IHD）入院的黑人和白人患者接受心脏病专家护理、30天内再入院以及1年生存率相关。
利用Optum的临床信息数据集市，我们使用混合效应模型研究了2010年至2018年医院SI对以HF或IHD为主要诊断入院的黑人和白人患者的影响。医院按SI三分位数分组。
总体而言，分析了119272例HF患者（29.4%为黑人，70.6%为白人）和183165例IHD患者（17.9%为黑人，82.1%为白人）。在SI三分位数中，与白人患者相比，HF黑人患者接受心脏病专家护理的几率较低。在SI三分位数和心脏病护理方面，种族间再入院风险没有差异，黑人患者1年生存率的几率更高。在IHD患者中，不同种族在SI三分位数中接受心脏病护理的几率没有差异。在高SI医院，未接受心脏病专家诊治的黑人患者再入院风险高20%（HR：1.20；95%CI：1.00-1.44）。在低SI医院接受心脏病专家诊治的黑人患者1年生存率的几率更高（OR：1.10；95%CI：1.04-1.17）。
在黑人和白人患者中，HF结局在SI三分位数中没有差异。然而，在IHD中，SI影响黑人患者的再入院风险和生存率。
