在为少数群体服务的医院中,在中风后的动脉再血管化中存在种族差异
Jeffrey Balian1, Oh Jin Kwon1, Kevin Tabibian1
1Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at University of California, Los Angeles, CA.
Journal of vascular surgery
|October 4, 2025
概括
服务于少数群体的医院 (MSHs) 对中风患者提供较少的动脉再血管,导致更糟糕的结果. 增加对MSH的资源可以改善少数群体患者的健康公平.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 血管外科 血管外科
- 健康 公平 卫生 公平
背景情况:
- 在缺血性中风后的动脉再血管化的种族差异可能源于机构因素.
- 服务于少数群体的医院 (MSHs) 服务于高比例的服务不足人口,可能会导致这些差异.
研究的目的:
- 评估MSHs治疗与急性缺血性中风的动脉复血管化后的结果之间的关联.
- 确定与医院类型相关的护理和结果的潜在差异.
主要方法:
- 分析由于动脉狭窄引起的急性缺血性中风的成年患者 (2016-2021年全国住院患者样本).
- 排除缺少数据的患者,选择性状态,或在低体积重血管化中心 (≤5次/年) 接受治疗的患者.
- 多变量回归模型评估了MSH状态与复血管化率,住院死亡率,心肌梗塞 (MI),住院时间 (LOS),住院费用和出院倾向的关联.
主要成果:
- 与非MSH相比,MSHs执行动脉再血管化的几率明显较低 (AOR,0.80).
- 在MSHs的治疗与类似的住院死亡率有关,但增加了心脏病发作 (AOR,1.17) 和死亡/心脏病发作 (AOR,1.14) 的几率.
- MSH护理与长时间的LOS,更高的成本和非家庭出院率的增加相关;西班牙裔患者仅在MSH有较低的再血管化几率.
结论:
- 与非MSH相比,MSH与下垂动脉复血管化率的降低和中风后的较差结果有关.
- 针对MSH的有针对性的资源分配和质量倡议对于实现中风护理中的健康公平至关重要.
- 进一步的研究应侧重于为MSHs量身定制的医院质量改善战略.
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