来自社会经济困难社区的患者进行心脏移植
Qiudong Chen1, Jad Malas1, Dominic Emerson1
1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
概括
来自社会经济困难社区的患者在心脏移植中面临更糟糕的结果,包括更高的等待名单死亡率和更低的生存率. 这凸显了需要解决社区层面的社会经济差异在移植护理.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 健康差距 研究 研究 研究 研究
背景情况:
- 之前关于心脏移植差异的研究集中在种族和保险等个人因素上.
- 这项研究调查了社区社会经济劣势对心脏移植结果的影响.
研究的目的:
- 描述一个复合社区社会经济劣势指数对心脏移植结果的影响.
- 为了比较来自困境社区的心脏移植候选人的结果与其他人的结果.
主要方法:
- 利用了来自移植受体科学注册局 (SRTR) 的49340名成年心脏移植候选人的数据 (2005-2020).
- 在邮政编码层面使用困难社区指数 (DCI) 评估社区的社会经济劣势.
- 对来自困境社区的患者 (DCI ≥80) 与所有其他患者的结果进行比较.
主要成果:
- 来自困难社区的患者更有可能不是白人,受教育程度较低,并拥有公共保险.
- 这些患者使用心室辅助器件的比例更高,并且在体积较小的中心进行了移植.
- 陷入困境的社区患者经历了1年等候名单死亡率/恶化增加和5年生存率较低.
- 生活在一个陷入困境的社区独立地与等待名单和移植后死亡率的风险增加有关.
结论:
- 来自社会经济困难社区的患者表现出更糟糕的等待名单和移植后死亡率.
- 研究结果强调,需要进一步研究心脏移植中社区层面社会经济差异的机制.
- 结果应该为减轻差异的战略提供信息,而不是限制获得护理的机会.
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