社会脆弱性对心脏移植后的长期结果的重要性
Alejandro Suarez-Pierre1, John Iguidbashian1, Michael J Kirsch1
1Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
概括
社会脆弱性会影响心脏移植的结果. 脆弱地区的患者的5年生存率较低,再入院率更高,移植排斥率更高,突出显示需要有针对性的支持.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 移植医学 移植医学
背景情况:
- 健康的社会决定因素 (SDOH) 显著影响患者的治疗结果,但在心脏移植中尚未得到充分研究.
- 社会脆弱性指数 (SVI) 使用人口普查数据量化社区层面的脆弱性,为评估SDOH影响提供了一个工具.
研究的目的:
- 调查社会脆弱性指数 (SVI) 与心脏移植后结果之间的关联.
- 为了确定较高的SVI是否与不良事件有关,包括死亡率,再入院和移植排斥.
主要方法:
- 从2012年至2021年,对23700名成年心脏移植接受者的回顾性分析.
- 受益人分为低 (SVI <75%) 和高 (SVI ≥75%) 的脆弱性群体.
- 主要终点:生存;次要终点:医院再入院和移植的拒绝率.
主要成果:
- 在SVI组之间,一年生存率是可比的 (91.4%和90.7%).
- 在高SVI地区,即使经过风险调整后,五年生存率也明显较低 (74.8%vs 80.0%,P < .001).
- 在脆弱人群中观察到5年再入院 (81.4%与75.4%) 和移植排斥 (40.3%与35.7%) 的更高发病率.
结论:
- 在社会脆弱的社区生活与心脏移植后的长期结果较差有关.
- 在高SVI地区的个人面临死亡率,再接收和移植拒绝的风险增加.
- 针对脆弱的心脏移植接受者的有针对性的干预措施对于改善长期存活率和移植成功至关重要.
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