Siddique R M, Siddique M I, Connors A F, Rimm A A
Department of Epidemiology, Case Western Reserve University, School of Medicine at MetroHealth Medical Center, Cleveland, Ohio, USA.
Arch Intern Med. 1996 Nov 11;156(20):2343-7.
Short-term race- and sex-specific case- fatality rates for pulmonary embolism (PE) in the elderly have not been studied previously, to our knowledge.
To examine 30-day race- and sex-specific case-fatality rates of PE in the Medicare population and to determine the risk of fatality when PE was a secondary diagnosis in 6 primary concurrent conditions and 3 surgical procedures.
Case-fatality rates were determined using the Medicare Provider Analysis and Review Record tiles from 1984 through 1991. All Medicare Part A beneficiaries aged 65 years or older were included, yielding more than 400,000 patients with PE. Case-fatality rates 30 days from hospital admission were calculated for both a primary discharge diagnosis of PE and a secondary discharge diagnosis of PE.
Blacks with PE as a primary discharge diagnosis had an overall age-adjusted case-fatality rate of 16.1% compared with a rate of 12.9% for whites. When PE was a secondary diagnosis, blacks also had higher rates than whites (34.7% vs 30.2%). Men had a fatality rate of 13.7% whereas women had a rate of 12.8% when PE was the primary diagnosis. For a secondary diagnosis of PE, men had a rate of 32.8% compared with a rate of 28.6% for women. The risk of fatality was very high when PE was a secondary discharge diagnosis in 6 primary concurrent conditions (congestive heart failure, cancer, chronic obstructive pulmonary disease, myocardial infarction, hip fracture, and stroke) and 3 common surgical procedures (coronary artery bypass graft, hip replacement, and knee replacement) relative to the case-fatality rate when PE was not present in these conditions.
Our results indicate that there are racial and gender differences in 30-day case-fatality rates for PE in elderly patients. The high fatality risk associated with PE as a comorbid factor among common primary concurrent conditions and procedures calls attention to the need for more effective prophylaxis of deep vein thrombosis and rapid diagnosis and treatment of PE when it occurs.
据我们所知，此前尚未对老年人肺栓塞（PE）的短期种族和性别特异性病死率进行研究。
研究医疗保险人群中PE的30天种族和性别特异性病死率，并确定PE作为6种主要并发疾病和3种外科手术的次要诊断时的死亡风险。
使用1984年至1991年医疗保险提供者分析和审查记录数据确定病死率。纳入所有65岁及以上的医疗保险A部分受益人，产生了超过400,000例PE患者。计算了PE作为主要出院诊断和次要出院诊断时入院30天的病死率。
以PE作为主要出院诊断的黑人总体年龄调整病死率为16.1%，而白人为12.9%。当PE为次要诊断时，黑人的病死率也高于白人（34.7%对30.2%）。当PE为主要诊断时，男性病死率为13.7%，女性为12.8%。对于PE的次要诊断，男性病死率为32.8%，女性为28.6%。当PE作为6种主要并发疾病（充血性心力衰竭、癌症、慢性阻塞性肺疾病、心肌梗死、髋部骨折和中风）和3种常见外科手术（冠状动脉搭桥术、髋关节置换术和膝关节置换术）的次要出院诊断时，相对于这些疾病中不存在PE时的病死率，死亡风险非常高。
我们的结果表明，老年患者PE的30天病死率存在种族和性别差异。PE作为常见主要并发疾病和手术中的合并因素所带来的高死亡风险，提醒人们需要更有效地预防深静脉血栓形成，并在PE发生时进行快速诊断和治疗。
