在接受主动脉置换的老黑白患者中,治疗的变化
Erik B Schelbert1, Gary E Rosenthal, Karl F Welke
1Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. erik-schelbert@uiowa.edu
Circulation
|October 6, 2005
概括
心脏护理中的种族差异可能源于医院的选择,而不仅仅是医生偏见. 黑人患者更喜欢使用生物假体门较少的医院,在考虑医院实践模式后,掩盖了更高的使用率.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 健康差异 在健康上的差异
背景情况:
- 以前关于心脏护理种族差异的研究往往侧重于个体医生或医院治疗变异.
- 不同的医院选择由种族群体,考虑到不同的实践模式,是一个研究不足的因素在护理差异.
研究的目的:
- 调查医院选择对在动脉置换期间使用生物假体 (BPVs) 的种族差异的影响.
- 为了确定医院实践模式的差异是否解释了BPV使用中观察到的种族差异.
主要方法:
- 在1999年至2001年期间,对78,154名65岁以上的黑人和白人医疗保险受益者进行了比较分析,这些受益者接受了大动脉置换 (AVR).
- 利用通用线性混合模型来调整患者特征和医院级BPV使用情况.
- 检查了患者种族,医院BPV使用五分之一和整体BPV利用之间的关联.
主要成果:
- 最初,黑人患者在调整患者因素后显示生物假体门使用率较低 (RR 0.93).
- 黑人患者更有可能在使用BPV率最低的医院接受治疗 (29%对20%).
- 在考虑了医院一级的实践模式后,生物假体门的使用率在黑人患者中更高 (RR 1.06).
结论:
- 医院的选择显著地影响了在动脉置换中使用生物假体的明显种族差异.
- 医院一级的实践变化占BPV使用变化的比例比仅仅种族或患者特征更大.
- 这凸显了考虑医院效应在理解和解决心血管保健中的种族不平等问题的重要性.
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