Giacomini M K
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
Arch Intern Med. 1996 Jun 10;156(11):1217-24.
To examine several hospital-based procedures for systematic utilization differences between the genders and among ethnic groups (Asian, black, Latino, and white).
California hospital discharges in 1989 and 1990 were sampled by principal diagnosis. Odds ratios for treatment by demographic class were estimated for heart transplantation, kidney transplantation, extracorporeal shockwave lithotripsy, hip replacement, carotid endarterectomy, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, pacemaker implant, and automatic cardioverter-defibrillator implant. Logistic regression controlled for insurance status, age, diagnosis, and comorbidity count.
The following results were statistically significant (P < .05). Males' odds of receiving most procedures exceeded those of females by 115% (odds ratio, 2.15) for coronary artery bypass grafting, 86% for heart transplantation, 38% for defibrillator implants, 34% for angioplasty, 28% for pacemaker implants, and 24% for hip replacement. Whites' odds of receiving several procedures exceeded those of blacks by 204% for kidney transplantation, 186% for defibrillator implant, 144% for coronary artery bypass grafting, 127% for endarterectomy, and 100% for angioplasty. Whites' odds of receiving some procedures also exceeded those of Latinos by 72% for angioplasty, 58% for kidney transplantation, and 49% for coronary artery bypass grafting. Whites' odds of receiving endarterectomy or angioplasty exceeded those of Asians by 108% and 30%, respectively. Asians had 113% higher odds than whites of receiving hip replacement.
The array of utilization differences across 4 demographic comparisons and 9 hospital procedures suggests systematic trends in high-technology allocation. Generally, women received procedures less often than men and minorities less than whites.
研究几种基于医院的程序在性别和不同种族群体（亚洲人、黑人、拉丁裔和白人）之间的系统利用差异。
通过主要诊断对1989年和1990年加利福尼亚州医院出院病例进行抽样。估计了心脏移植、肾脏移植、体外冲击波碎石术、髋关节置换术、颈动脉内膜切除术、冠状动脉搭桥术、经皮腔内冠状动脉成形术、起搏器植入术和自动心脏复律除颤器植入术按人口统计学类别治疗的比值比。逻辑回归控制了保险状况、年龄、诊断和合并症数量。
以下结果具有统计学意义（P <.05）。在冠状动脉搭桥术中，男性接受大多数手术的几率比女性高出115%（比值比，2.15），心脏移植高出86%，除颤器植入高出38%，血管成形术高出34%，起搏器植入高出28%，髋关节置换高出24%。在肾脏移植中，白人接受几种手术的几率比黑人高出204%，除颤器植入高出186%，冠状动脉搭桥术高出144%，内膜切除术高出127%，血管成形术高出100%。在血管成形术中，白人接受某些手术的几率比拉丁裔高出72%，肾脏移植高出58%，冠状动脉搭桥术高出49%。白人接受内膜切除术或血管成形术的几率分别比亚洲人高出108%和30%。亚洲人接受髋关节置换的几率比白人高113%。
4种人口统计学比较和9种医院手术的利用差异表明在高科技分配方面存在系统趋势。一般来说，女性接受手术的频率低于男性，少数族裔低于白人。
