Coughlin S S, Gottdiener J S, Baughman K L, Wasserman A, Marx E S, Tefft M C, Gersh B J
Department of Medicine, Lombardi Cancer Research Center, Georgetown University School of Medicine, Washington, DC.
J Natl Med Assoc. 1994 Aug;86(8):583-91.
Racial, socioeconomic, and clinical factors were examined as predictors of survival in idiopathic dilated cardiomyopathy using cases from five Washington, DC-area hospitals. One hundred three (80.5%) of the patients were black and 25 (19.5%) were white. The black patients were less likely to have private health insurance, less educated on average, and more likely to have a household income of $15,000 or less (P < or = .05). No racial differences were found in cardiac medication usage, with the exception of beta blockers and antiarrhythmics. The cumulative survival among black patients at 12 and 24 months was 71.5% and 63.6%, respectively, as compared with 92.0% and 86.3% among whites. The 12-month survival of black patients with ventricular arrhythmias or an ejection fraction of less than 25% was particularly poor. Age, ventricular arrhythmias, ejection fraction, and cigarette usage were significant predictors of survival in univariate analysis using the proportional hazards model. The univariate association with black race was of borderline significance (P < or = .07). In multivariate analysis, age and race were statistically significant independent predictors of survival. A strong association with black race was observed with an estimated relative risk of mortality of 5.41 (P < or = .02) after adjustment for age, ejection fraction, ventricular arrhythmias, and educational attainment. Poorer survival among blacks may be caused by a greater severity of disease at the time of diagnosis or by racial differences in cardiac care, comorbid conditions, or biologic factors affecting survival.
利用来自华盛顿特区地区五家医院的病例，对种族、社会经济和临床因素进行了研究，以确定其作为特发性扩张型心肌病患者生存预测指标的作用。103名（80.5%）患者为黑人，25名（19.5%）为白人。黑人患者拥有私人医疗保险的可能性较小，平均受教育程度较低，家庭收入在15,000美元及以下的可能性更大（P≤0.05）。除β受体阻滞剂和抗心律失常药物外，在心脏药物使用方面未发现种族差异。黑人患者在12个月和24个月时的累积生存率分别为71.5%和63.6%，而白人分别为92.0%和86.3%。患有室性心律失常或射血分数低于25%的黑人患者12个月生存率尤其低。在使用比例风险模型进行的单因素分析中，年龄、室性心律失常、射血分数和吸烟是生存的重要预测指标。与黑人种族的单因素关联具有临界显著性（P≤0.07）。在多因素分析中，年龄和种族是生存的统计学显著独立预测指标。在对年龄、射血分数、室性心律失常和教育程度进行调整后，观察到与黑人种族有很强的关联，估计死亡相对风险为5.41（P≤0.02）。黑人患者较差的生存率可能是由于诊断时疾病严重程度较高，或由于心脏护理、合并症或影响生存的生物学因素方面的种族差异所致。
