结节病黑人患者转诊至多学科护理的延迟情况。
Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis.
作者信息
Mathias Kristen R, Akhiwu Ofure, Mustafa Ali M, Psoter Kevin J, Chen Edward S, Gilotra Nisha A, Lin Nancy W, Odackal John, Bonham Catherine A, Sharp Michelle
机构信息
Division of Rheumatology (K. R. M.), Johns Hopkins University, Baltimore, MD; the Division of Pulmonary & Critical Care (O. A.), Yale School of Medicine, New Haven, CT; the Divisions of Pulmonary & Critical Care Medicine (A. M. M., E. S. C., N. W. L., and M. S.), and Cardiology (N. A. G.), and Department of General Pediatrics (K. J. P.), Johns Hopkins University, Baltimore, MD; the Division of Pulmonary, Critical Care & Sleep Medicine (J. O.), The Ohio State University, Columbus, OH; and the Division of Pulmonary & Critical Care (C. A. B.), University of Virginia, Charlottesville, VA.
出版信息
CHEST Pulm. 2025 Jun;3(2). doi: 10.1016/j.chpulm.2024.100125. Epub 2024 Dec 2.
BACKGROUND
Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.
RESEARCH QUESTION
Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?
STUDY DESIGN AND METHODS
We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.
RESULTS
At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively ( < .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; < .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.
INTERPRETATION
Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.
背景
结节病是一种复杂的肉芽肿性疾病，需要多学科专业知识的支持。在许多疾病中，医疗服务获取的不平等导致了种族差异；然而，据我们所知，尚无研究探讨转诊至结节病卓越中心的时间上的种族差异。
研究问题
从结节病诊断到转诊至经独立认证、同行评审的世界结节病及其他肉芽肿性疾病协会卓越中心，种族与时间之间是否存在关联？转诊是否会导致结节病管理的改变？
研究设计与方法
我们回顾性分析了2021年所有转诊至约翰霍普金斯结节病卓越中心的病例。多变量Cox回归评估了种族与转诊时间之间的关联，并对性别、种族、转诊类型、转诊提供者、保险提供者、就业状况、器官受累情况和结节病用药等协变量进行了调整。在建立护理1年后，确定结节病管理的变化，包括治疗变化、额外的器官评估和/或额外的专科专业知识。
结果
共分析了207名个体（40%为黑人，55%为白人，5%为亚洲人和其他种族）。黑人个体的转诊延迟时间比白人个体更长，中位数分别为9年和5年（P<0.05）。在多变量分析中，白人个体的转诊风险高于黑人个体（风险比，2.04；95%置信区间，1.48-2.82；P<0.001），与协变量无关。转诊后，78%的个体结节病管理发生了变化。
解读
与其他种族群体相比，黑人患者在转诊至多学科专科结节病卓越中心时经历了显著延迟。认识到转诊延迟可能为解决结节病黑人个体中观察到的临床结果差异提供见解和机会。未来的多中心研究必须量化通过世界结节病及其他肉芽肿性疾病协会结节病卓越中心接受的护理的影响，确定需要紧急转诊的患者表型，并开展有针对性的患者和提供者宣传。
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