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在上胃肠道出血治疗中的种族差异
Riley Scherr1,2, Jacqueline J Chow3, Caitlyn Sing3
1School of Medicine, University of California Irvine, Irvine, CA, USA. rscherr@hs.uci.edu.
Journal of racial and ethnic health disparities
|February 27, 2025
概括
非西班牙裔黑人患者因上部胃肠道出血而经历了更长的住院时间,尽管与白人患者相比,治疗和死亡率相似. 考虑到各种因素,特别是干预性放射治疗后,这些停留时间的差异仍然存在.
科学领域:
- 胃肠病学 胃肠病学
- 医疗保健服务研究 医疗服务研究
- 健康差异 在健康上的差异
背景情况:
- 急性上部胃肠道 (GI) 出血是一种关键状况,需要及时有效治疗.
- 了解治疗结果的人口预测因素对于公平的医疗保健服务至关重要.
- 种族和社会经济地位是与先进治疗,死亡率和停留时间 (LOS) 相关的关键因素.
研究的目的:
- 为了确定人口预测因素,特别是种族和社会经济地位,与高级治疗方式,死亡率和上部肠道出血患者的停留时间 (LOS) 相关.
- 调查上部胃肠道出血的治疗和结果的种族差异.
- 分析社会经济地位对上部胃肠道出血管理和患者结局的影响.
主要方法:
- 利用来自医疗保健成本和利用项目 (HCUP) 的国家住院患者样本 (NIS) 来查看2016年至2021年间的住院病例.
- 将治疗分为干预性放射学 (IR) 和非IR (内镜) 模式.
- 进行统计分析,包括计算几率比率和置信区间,以评估死亡率和平均LOS,同时控制混因素.
主要成果:
- 白人患者和非西班牙裔 (NH) 黑人或西班牙裔患者之间没有观察到接受干预放射学 (IR) 程序的可能性或死亡率的显著差异.
- 与白人患者 (9.57天) 相比,NH黑人患者的LOS显著更长 (12.61天),这种差异在各种匹配条件中持续存在,包括社会经济地位和并发症.
- 在COVID-19后的时代,在匹配条件下没有观察到这些逗留时间差异.
结论:
- 该研究发现了上部胃肠道出血LOS的显著种族差异,特别是在NH黑人患者中,在高级治疗利用率或死亡率上没有相应的差异.
- 虽然混杂因素在非IR治疗中影响了LOS,但NH黑人患者在IR治疗后持续经历了比白人患者更长的LOS.
- 调查结果强调需要解决导致特定人口群体在急性上部消化道出血后长时间住院的系统因素.
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