大动脉置换术后的程序选择和结果的社会经济差异
Paige E Brlecic1, Katie J Hogan1,2, John A Treffalls1,3
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
JTCVS open
|January 11, 2024
概括
具有较低社会经济地位 (SES) 的患者更有可能接受外科动脉置换 (SAVR) 手术,并在SAVR后经历较高的再入院率,而不是通过导管动脉置换 (TAVR). 这突显了心血管保健中的健康不平等.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
背景情况:
- 大动脉置换 (AVR) 是严重的大动脉狭窄的关键手术.
- 手术性大动脉置换 (SAVR) 和透气管大动脉置换 (TAVR) 是主要的治疗选择.
- 了解AVR程序选择和结果的社会经济差异对于公平的护理至关重要.
研究的目的:
- 调查SAVR和TAVR之间的选择中可能存在的社会经济差异.
- 根据SAVR和TAVR,研究再接收率的社会经济差异.
主要方法:
- 全国再接收数据库 (2016-2018) 对243,691名接受隔离SAVR或TAVR的患者的分析.
- 基于社会经济地位 (SES) 的患者分层.
- 多变量分析,以评估SES对程序选择和再接收结果的影响.
主要成果:
- 与TAVR相比,较低的SES独立地与接受SAVR的可能性更高有关.
- 低SES患者在SAVR后经历了显著增加的30天,90天和1年的再入院.
- 在TAVR后,较低的SES和再接收率之间没有明显的关联.
结论:
- 社会经济地位显著影响AVR手术的选择,较低SES患者更喜欢SAVR.
- 健康不平等存在,因为较低的SES与SAVR后但不是TAVR后再录取增加有关.
- 与SAVR相比,TAVR可能会减轻一些再接收结果的社会经济差异.
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