低社会经济地位会对冠状动脉旁路移植后的结果产生不利影响
Paige E Brlecic1, Christopher B Sylvester2, Katie J Hogan2
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, Tex.
The Journal of thoracic and cardiovascular surgery
|January 21, 2025
概括
具有较低社会经济地位 (SES) 的患者在冠状动脉旁路移植 (CABG) 后面临更高的死亡率和再接收风险. 这项研究突出了这一重大心脏手术后基于SES的结果的显著差异.
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:
- 社会经济地位 (SES) 是已知的健康结果的决定因素.
- 有限的数据存在于SES对冠状动脉旁路移植 (CABG) 后再接收率的影响.
- 了解这些差异对于改善术后护理和资源配置至关重要.
研究的目的:
- 分析SES对CABG后再接收,资源利用和死亡率的影响.
- 在一个大型的国家队列中评估风险调整后的结果.
- 确定与SES相关的特定患者和医院因素.
主要方法:
- 使用全国再接收数据库 (NRD) 来查看2016-2018年间的单独CABG病例.
- 使用ICD-10-CM代码,人口统计和邻里数据,获得SES (低,中,高).
- 采用多变量分析来评估SES对风险调整结果的影响.
主要成果:
- 低SES患者 (25.6%) 更有可能是女性,年轻,来自农村地区,并紧急入院.
- 低SES与更高的并发症得分和在教学医院的治疗频率较低有关.
- 风险调整后的分析显示,低SES患者的住院死亡率 (OR 1.464),住院时间更长,以及30天 (OR 1.229),90天 (OR 1.281) 和每年再入院 (HR 1.234) 的几率在低SES患者相比高SES患者中显著增加.
结论:
- 低SES患者经历CABG后明显更高的调整后死亡率和再入院率.
- 这些发现强调了心血管手术结果的社会经济差异.
- 有针对性的干预措施可能是必要的,以减轻这些不利结果在弱势群体.
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