退役軍人の保健医療システムで入院した男性の死亡率における人種差異
A K Jha1, M G Shlipak, W Hosmer
1General Internal Medicine Section (111A1), Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121, USA. ashishkjha@yahoo.com
JAMA
|February 15, 2001
まとめ
ベテラン事務 (VA) の病院に入院した黒人の患者は,白人患者よりも死亡率が低い. VAシステムにおけるこの生存優位性は,医療への平等なアクセスと質の高い入院治療を反映している可能性があります.
科学分野:
- 医療サービス 研究 医療サービス
- 健康の格差について
- クリニカルアウトカム
背景:
- 医療成果における人種差異は,医療へのアクセスの不平等としばしば結びついている.
- 平等なアクセスシステムにおける健康上の結果における人種差異を調査した研究はほとんどありません.
研究 の 目的:
- ベテラン事務 (VA) の保健医療システム内の患者の死亡率における人種差を調査する.
- 平等なアクセス制度が,患者の治療結果における人種的差異を軽減するかどうかを評価する.
主な方法:
- コーホート研究では,147のVA病院に入院した28,934人の白人および7,575人の黒人男性患者が分析されました.
- 1995年10月から1996年9月までの間に,患者さんが6つの一般的な医療診断のために入院しました.
- プライマリアウトカムは30日間の死亡率であり,二次的なアウトカムには入院死亡率と6ヶ月の死亡率が含まれていました.
主要な成果:
- 30日間の全死亡率は,白人の患者 (5.8%) と比べて黒人の患者 (4.5%) の方が低かった (RR, 0.77;P =.001).
- 黒人患者は,多変量調整 (RR,0.75;P<.001) の後でも,すべての6つの診断においてより低い死亡率を示した.
- 黒人患者では,病院内および6ヶ月の死亡率に調整されたより低い死亡率も観察されました.
結論:
- 退役軍人の病院に入院した黒人の患者は,白人の患者よりも低い死亡率を示した.
- 黒人患者の生存率が優れていることは,さらなる調査が必要である.
- この調査結果は,平等な医療アクセスと質の高い入院医療が,人種差の減少に役立つ可能性があることを示唆しています.
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