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生活在弱势社区与严重的大动脉狭窄症的干预减少有关

Chirag Ram^1,2, Sameh Yousef¹, Wei-Guo Ma¹

¹Division of Cardiac Surgery, Yale Aortic Institute, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT, 06520, USA.

Scientific reports

|February 28, 2024

概括

生活在贫困地区的严重大动脉狭窄症 (AS) 患者接受大动脉置换 (AVR) 的可能性较低. 这种差异受女性性别和非洲裔美国人种族的影响,突出了心血管保健获得的社会经济因素.

科学领域:

心血管医学心血管医学
医疗保健服务研究医疗服务研究
健康的社会经济决定因素

背景情况:

严重的大动脉狭窄 (AS) 是一种需要及时干预的危急情况.
社会经济因素,如社区贫困,可能会影响获得和接受指导方针导向的医疗治疗.
区域贫困指数 (ADI) 是一个验证的社区层面社会经济劣势的衡量标准.

研究的目的:

检查区域剥夺指数 (ADI) 与严重AS患者进行大动脉置换 (AVR) 的可能性之间的关联.
确定可能调解或修改这种关联的人口和临床因素.

主要方法:

对1751名年龄在40-95岁的患有严重AS的患者进行了回顾性队列研究,通过心声学证实了这一点.
区域贫困指数 (ADI) 通过居住的9位邮政编码来确定,将患者分为5组 (A-E,E最贫困).
竞争性风险分析被用来比较ADI组之间的AVR率,死亡作为竞争性事件. 根据性别和种族进行了子组分析.

主要成果:

缺乏ADI的患者较少发生AVR (39.7%在E组与52.5%在A组,P=0.023).
较高的ADI与年轻的年龄,女性性别,非洲裔美国人种族以及毒症和心律失常等并发症的增加有关.
ADI和AVR之间的关联受到性别和种族的显著影响,这两个因素独立地与AVR率相关.

结论:

居住在更贫困社区的严重AS患者对主动脉置换的机会有所减少.
女性性别和非洲裔美国人种族是导致AVR收件差异的关键因素.
解决社会经济和种族差异至关重要,以确保严重AS患者平等获得心血管干预.

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