社会经济财富对2016年至2023年医疗保险患者中CLTI再血管化结果的影响
Maxime Dubosq-Lebaz1, Joseph M Kim1, Siling Li1
1Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Journal of vascular surgery
|August 30, 2025
概括
社会经济差异对慢性肢体威胁性缺血 (CLTI) 患者的影响很大. 这些差异在COVID-19疫情期间和之后变得更加严重,需要有针对性的干预措施来改善护理.
科学领域:
- 血管外科
- 医疗服务研究
- 医疗公平
背景情况:
- 对于治疗慢性肢体威胁性缺血症 (CLTI) 来说,及时的再血管化是至关重要的.
- 社会经济地位 (SES) 和获得医疗保健的差异影响了CLTI的结果.
- COVID-19 疫情加剧了现有的健康不平等,对其对 CLTI 结果的影响的研究有限.
研究的目的:
- 通过困难社区指数 (DCI) 衡量区域社会经济地位 (SES) 与CLTI重血管化结果之间的关联.
- 评估这些关联在COVID-19大流行之前,期间和之后如何变化.
- 分析医疗保险受益者死亡率,重大截肢和重复干预的结果.
主要方法:
- 从2016年到2023年接受CLTI内血管再循环治疗的医疗保险受益人的回顾性分析.
- 根据使用DCI的SES对患者进行分层 (压力:≥80百分位数).
- 使用卡普兰-梅尔和考克斯模型,比较流行前,流行后和流行后期的结果.
主要成果:
- 患有困难社区的患者 (20. 0%) 面临更高的截肢和死亡风险 (HR1. 04).
- 在大流行 (HR 1.06) 和大流行后期 (HR 1.07) 期间,这些差异持续并恶化.
- 患有困难社区的患者减少了皮肤血管干预,并增加了急救诊所和再入院.
结论:
- 区域社会经济差异显著影响了CLTI复血管化结果和医疗保健利用率.
- 这些差异在COVID-19大流行期间扩大,并在大流行后继续存在.
- 迫切需要资源和干预措施来解决这些护理缺口,并改善弱势群体的CLTI管理.
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