2016年から2023年までのメディケアの患者におけるCLTI再血管化の結果に対する社会経済的富の影響
Maxime Dubosq-Lebaz1, Joseph M Kim1, Siling Li1
1Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Journal of vascular surgery
|August 30, 2025
まとめ
社会経済的格差は,慢性四肢の危険性のある不血症 (CLTI) の患者の結果に大きく影響します. これらの格差は,COVID-19のパンデミック期間とその後で悪化し,ケアを改善するために標的を絞った介入が必要になりました.
科学分野:
- 血管 外科
- 医療サービス研究
- 健康に関する公平性
背景:
- 慢性四肢の危険性のある缺血症 (CLTI) の管理に迅速な再血管化は不可欠です.
- 社会経済的地位 (SES) と医療へのアクセスの格差が CLTI の結果に影響します.
- COVID-19 パンデミックは既存の健康格差を悪化させ,CLTIの結果に対する影響に関する研究は限られている.
研究 の 目的:
- 困窮地域指数 (DCI) で測定される地域社会経済的地位 (SES) と,CLTIの再循環化結果との関連を評価する.
- これらの関連がCOVID-19のパンデミック前,中,および後にどのように変化したかを評価する.
- メディケアの受給者における死亡率,大切断,再介入などの結果を分析する.
主な方法:
- 2016年から2023年までCLTI内血管再循環手術を受けたメディケア受給者の遡及的分析.
- DCIを使用したSESに基づく患者の層分化 (ストレス:80パーセント).
- カプラン・マイヤーとコックスのモデルを用いて,疫病前,疫病後期における結果の比較.
主要な成果:
- 困窮しているコミュニティの患者 (20. 0%) は,大きな切断と死亡率 (HR1. 04) の高いリスクに直面しました.
- これらの格差は,パンデミック (HR 1.06) とパンデミック後期 (HR 1.07) の間に持続し,悪化した.
- 困った地域に住む患者では 皮膚経由の血管介入が減り,緊急治療室への訪問や再入院が増加しました.
結論:
- DCIによって示された地域社会経済的格差は,CLTIの再循環化結果と医療利用に大きな影響を及ぼします.
- これらの格差は,COVID-19のパンデミック期間中に拡大し,パンデミック後も続きました.
- これらのケアギャップを埋め 脆弱な集団のCLTI管理を改善するために 資源と介入が不可欠です
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