对肢体缺血的治疗指示和治疗结果的种族差异
Dana B Semaan1, Othman M Abdul-Malak1, Efthymios D Avgerinos1
1Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
Annals of vascular surgery
|September 22, 2023
概括
在周围动脉疾病 (PAD) 的下肢旁路术 (LEB) 和周围血管干预 (PVI) 后,黑人个体经历了更糟糕的结果. 尽管ACA有所改善,但种族差异仍然存在,黑人患者面临更高的重大不良肢体事件 (MALE) 风险.
科学领域:
- 血管外科 血管外科
- 健康差距 研究 研究 研究 研究
- 公共卫生政策 公共卫生政策
背景情况:
- 2014年的"负担得起的医疗法案" (ACA) 旨在改善外周动脉疾病 (PAD) 患者的血管护理准入和治疗结果.
- 血管护理和结果的种族差异仍然存在,特别是在接受下肢旁路 (LEB) 或外周血管干预 (PVI) 的黑人个人中.
研究的目的:
- 对接受LEB或PVI的PAD患者的治疗结果的种族差异进行调查.
- 用血管质量倡议 (VQI) 数据库分析 ACA 对这些差异的影响.
主要方法:
- 在2016年至2021年期间,对选修/紧急LEB或PVI程序的VQI下语言和PVI数据集进行分析.
- 排除紧急/紧急干预和动脉瘤手术.
- 主要结局:无重大不良四肢事件 (MALE) 的1年生存期,定义为无需重新干预或脚以上截肢.
主要成果:
- 与非西班牙裔白人 (NHW) 患者相比,黑人患者出现了更晚期的PAD,并发病率更高 (糖尿病,高血压,ESRD) 和先前的截肢.
- 与NHW患者相比,黑人患者在LEB和PVI后的重大截肢和1年MALE的发生率显著更高.
- 经过调整的分析证实,黑人患者接受LEB (aHR 1.15) 和PVI (aHR 1.18) 的1年MALE风险更高,慢性肢体威胁性缺血症 (CLTI) 和先前截肢是显著的风险因素.
结论:
- 黑人患者出现更严重的血管疾病,在LEB和PVI之后面临着显著更高的1年MALE风险.
- 尽管ACA推动了护理可访问性的改善,但在血管干预结果方面仍然存在显著的种族差异.
- 需要进一步调查,以解决导致黑人患者持续存在这些差异的潜在变量.
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