Kuhn E M, Hartz A J, Baras M
Medical College of Wisconsin, Milwaukee 53226, USA.
Health Serv Res. 1995 Aug;30(3):425-36.
The rate of coronary artery bypass surgery (CABG) has been shown to vary greatly across geographic regions. This study examined whether these rates were associated with the rate of coronary artery angioplasty (PTCA) and with other community characteristics.
DATA SOURCES/STUDY SETTING: The health care financing administration provided the number of Medicare hospitalizations in 1988 for conditions and procedures related to coronary artery disease. Information on physicians and hospitals was obtained from the Area Resource File, and the number of persons in each age, sex, and race category was obtained from US. census data.
Age-and sex-adjusted hospitalization rates based on the patient's zip code of residence were calculated at the level of the Metropolitan Statistical Area (MSA) for white patients age 65 or older. Rates were obtained for 305 MSAs for CABG, PTCA, cardiac catheterization, angina, and myocardial infarction.
The rate of cardiac catheterization had a correlation of .72 with the CABG rate and .64 with the PTCA rate. The correlation of the PTCA and CABG rates with each other was .49. This correlation was not charged by adjusting for the rates of hospitalization for angina or myocardial infection, but it was reduced to only .05 (ns) after adjusting for the rate of cardiac catheterization. The rates of all three procedures had rank correlations of about .15 with the density of thoracic surgeons and about .30 with the density of hospitals with cardiac catheterization and open heart surgery units.
Community CABG and PTCA rates tend to move in the same direction due to community factors that also affect the rates of cardiac catheterization. These community factors do not appear to include the rate of coronary artery disease, but may include resources or attitudes toward aggressive treatment of coronary artery disease.
冠状动脉搭桥手术（CABG）的发生率在不同地理区域差异很大。本研究旨在探讨这些发生率是否与冠状动脉血管成形术（PTCA）的发生率以及其他社区特征相关。
数据来源/研究背景：医疗保健财务管理局提供了1988年医疗保险住院患者中与冠状动脉疾病相关的病症和手术的数量。医生和医院的信息来自区域资源文件，各年龄、性别和种族类别的人数来自美国人口普查数据。
基于患者居住邮政编码，在大都市统计区（MSA）层面计算65岁及以上白人患者的年龄和性别调整住院率。获取了305个MSA的CABG、PTCA、心导管插入术、心绞痛和心肌梗死的发生率。
心导管插入术的发生率与CABG发生率的相关性为0.72，与PTCA发生率的相关性为0.64。PTCA和CABG发生率之间的相关性为0.49。通过调整心绞痛或心肌感染的住院率，这种相关性没有改变，但在调整心导管插入术的发生率后，相关性降至仅0.05（无统计学意义）。所有这三种手术的发生率与胸外科医生密度的等级相关性约为0.15，与有心导管插入术和心脏直视手术科室的医院密度的等级相关性约为0.30。
由于同样影响心导管插入术发生率的社区因素，社区CABG和PTCA发生率往往朝着相同方向变化。这些社区因素似乎不包括冠状动脉疾病的发生率，但可能包括对冠状动脉疾病积极治疗的资源或态度。
