Khan Abdul Hadi, Ubaid Bushra, Abboud Elias, Chamorro Anggie Lorena Renteria, Chamorro Daniela Alejandra Renteria, Rios Kevin Camilo Mejia, Martínez Rodrigo Sandoval, Collins Peter, Ahmed Raheel
Jinnah Sindh Medical University, Karachi, Pakistan.
Dow University of Health Sciences, Karachi, Pakistan.
Egypt Heart J. 2025 Aug 12;77(1):80. doi: 10.1186/s43044-025-00675-7.
Ischemic heart disease (IHD) is the leading cause of death in adults and poses a substantial economic burden in the United States. Coronary artery bypass grafting (CABG) remains the standard surgical intervention for multivessel and left-main coronary disease. However, the combined impact of race and socioeconomic status on CABG outcomes has not been fully explored.
A total of 47,373 admissions of adults (18-85 y) who underwent CABG from 2016-2020 were analysed. Adults aged 18-85 years with a primary diagnosis of IHD who underwent CABG were identified using ICD-10 codes. Data on patient demographics, socioeconomic indicators (household income quartile, insurance type), comorbidities (Charlson Comorbidity Index), and hospital characteristics were collected. Multivariable logistic regression models adjusted for clinical and hospital factors were used to estimate adjusted odds ratios (aORs) for in-hospital mortality, nonhome discharge, prolonged length of stay (> 75th percentile), and postoperative complications. Linear regression assessed differences in hospital costs.
Compared to White patients, Black individuals had significantly higher odds of nonhome discharge (aOR 1.37), prolonged hospitalization (aOR 1.54), and postoperative complications (aOR 1.35) (all p < 0.001). Hispanic and Asian/Pacific Islander patients also faced increased risks of prolonged stay (aORs 1.23-1.26) and complications (aORs 1.15-1.19) (all p < 0.001). Minority groups incurred significantly higher hospitalization costs, with adjusted increases ranging from $17,000 to $73,000 per admission (p < 0.001). Trends toward elevated in-hospital mortality in Native American and Black patients did not reach statistical significance.
Racial and socioeconomic disparities persist in CABG outcomes and hospital resource utilization, despite adjustments for clinical and institutional factors. These findings underscore the need for targeted strategies to improve equity in cardiovascular surgical care, including enhanced access to preventive services, perioperative support, and system-level quality improvements.
Non-Hispanic Black and Hispanic patients experience higher postoperative complication rates and longer hospital stays after CABG. Native American and Black patients showed trends toward higher in-hospital mortality, though not statistically significant. Patients from socioeconomically disadvantaged backgrounds incur significantly higher hospital costs and are more likely to experience prolonged hospitalizations. Racial and socioeconomic disparities persist despite adjustment for comorbidities and hospital-level factors.
缺血性心脏病（IHD）是成年人死亡的主要原因，在美国造成了巨大的经济负担。冠状动脉旁路移植术（CABG）仍然是多支血管和左主干冠状动脉疾病的标准外科干预措施。然而，种族和社会经济地位对CABG手术结果的综合影响尚未得到充分探讨。
对2016年至2020年期间接受CABG手术的47373例成年人（18 - 85岁）入院病例进行分析。使用ICD - 10编码识别年龄在18 - 85岁、初步诊断为IHD且接受CABG手术的成年人。收集患者人口统计学数据、社会经济指标（家庭收入四分位数、保险类型）、合并症（Charlson合并症指数）和医院特征。采用针对临床和医院因素进行调整的多变量逻辑回归模型来估计住院死亡率、非家庭出院、住院时间延长（>第75百分位数）和术后并发症的调整优势比（aOR）。线性回归评估医院成本差异。
与白人患者相比，黑人非家庭出院（aOR 1.37）、住院时间延长（aOR 1.54）和术后并发症（aOR 1.35）的几率显著更高（均p < 0.001）。西班牙裔和亚裔/太平洋岛民患者也面临住院时间延长（aOR 1.23 - 1.26）和并发症（aOR 1.15 - 1.19）风险增加（均p < 0.001）。少数族裔群体的住院费用显著更高，每次入院调整后的增加幅度在17000美元至73000美元之间（p < 0.001）。美国原住民和黑人患者住院死亡率升高的趋势未达到统计学意义。
尽管对临床和机构因素进行了调整，但CABG手术结果和医院资源利用方面的种族和社会经济差异依然存在。这些发现强调了需要采取针对性策略来改善心血管外科护理的公平性，包括增加获得预防服务的机会、围手术期支持以及系统层面的质量改进。
非西班牙裔黑人和西班牙裔患者在CABG术后并发症发生率更高，住院时间更长。美国原住民和黑人患者住院死亡率有升高趋势，尽管未达到统计学意义。社会经济背景不利的患者住院费用显著更高，且更有可能经历住院时间延长。尽管对合并症和医院层面因素进行了调整，种族和社会经济差异仍然存在。
