皮肤冠状动脉干预后结果的种族/民族差异
Daniel R Wang1, Joshua Li2, Rushi V Parikh1
1Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
The American journal of cardiology
|August 19, 2023
概括
少数群体,包括亚裔美国人/太平洋岛民 (AAPI) 和西班牙裔,在皮肤冠状动脉干预 (PCI) 后,在心血管保健结果上面临差异. 与非西班牙裔白人 (NHWs) 相比,这些群体的死亡率更高,药物坚持不同.
科学领域:
- 心血管医学 心血管医学
- 健康差异 在健康上的差异
- 干预心脏病学 干预心脏病学
背景情况:
- 亚裔美国人/太平洋岛民 (AAPI) 和西班牙裔人口在美国人口不断增长,但在心血管医学文献中代表性不足.
- 现有的质量改善工作可能无法完全解决这些少数群体的护理差异.
研究的目的:
- 为了比较AAPI和西班牙裔与非西班牙裔白人 (NHWs) 在住院皮肤冠状动脉干预 (PCI) 后的指南遵守和临床结果.
- 确定种族和少数民族群体在PCI后的管理和结果中的特定差异.
主要方法:
- 从四级护理中心的住院患者数据的回顾性分析.
- 种族/民族群体之间的初级终点 (PCI后出血,心力衰竭,心脏性休克,因任何原因的死亡率) 和二级终点 (指导方针指导的医疗治疗处方率) 的比较.
- 统计分析包括ANOVA,奇平方测试和物流回归,NHW作为参考组.
主要成果:
- 与NHW相比,西班牙裔的PCI后死亡率明显高于NHW,无论是急性冠状动脉综合征 (OR 2.04) 还是选择性PCI (OR 2.51).
- 与NHW相比,AAPI显示糖尿病,高血压和透析的几率更高,并趋向于更高的死亡率.
- 在药物坚持方面观察到差异,AAPI对他类药物处方的几率较高,但对提卡格勒罗的几率较低,而西班牙裔人对提卡格勒罗的处方几率较低.
结论:
- 尽管有质量改进举措,但与NHW相比,西班牙裔和AAPI人群在PCI后的结果和准则遵守方面仍然存在显著的差异.
- 需要进一步的有针对性的干预措施来解决这些持续的健康不平等在心血管保健的少数群体.
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