在美国医疗保险患者中,慢性四肢威胁性缺血的结果和利用率存在持续的种族差异
Lorenzo V Arvanitis1, Joseph M Kim2, Siling Li3
1Harvard Medical School, Boston, MA; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA.
The American journal of cardiology
|October 6, 2025
概括
患有慢性肢体威胁性缺血症 (CLTI) 的黑人患者面临更高的截肢风险和较少的血管护理,尽管有国家努力. 这项研究强调了在CLTI治疗结果中持续存在的种族差异.
科学领域:
- 血管外科 血管外科
- 健康差距 研究 研究 研究 研究
- 医疗保健服务研究 医疗服务研究
背景情况:
- 慢性肢体威胁性缺血 (CLTI) 不成比例地影响种族少数群体,黑人患者经历了更糟糕的结果和有限的血管护理机会.
- 针对外围动脉疾病 (PAD) 查的国家运动并没有明显改善黑人患者的CLTI结果.
- 在CLTI护理中存在的差异需要检查治疗和结果的时间趋势.
研究的目的:
- 评估内血管再血管化治疗的时间趋势,患者的治疗结果和黑人与白人的医疗保险受益者与CLTI的医疗保健利用情况.
- 为了确定接受CLTI治疗的种族群体之间的护理和结果的差异.
- 为制定有针对性的干预措施提供信息,以解决CLTI管理中的种族不平等问题.
主要方法:
- 使用2016年1月至2023年12月的Medicare索赔数据进行回顾性队列研究.
- 纳入标准:年龄66岁以上的医疗保险受益者,为CLTI接受内血管再血管化.
- 主要结局:主要截肢或4年内死亡的组合;次要结局:医疗保健利用指标 (血管检查,ED使用,住院).
主要成果:
- 该队列包括303,906名患者,其中17.2%的患者是黑人;黑人患者出现了更多的并发症和.
- 黑人患者的重大截肢风险更高 (HR 1.49) 和死亡率更低 (HR 0.91),但接受血管造形术的频率比支架更高.
- 黑人患者在重血管化前和后的血管检查较少,但ED检查和再入院的比例较高.
结论:
- 尽管有国家倡议,但在患有CLTI的黑人患者中仍然存在显著的种族差异,包括更高的截肢率.
- 黑人患者经历了经过再血管化的持续,纵向血管护理的减少.
- 持续的,以公平为重点的干预措施对于减轻差异和改善CLTI黑人患者的结果至关重要.
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