Racial trends in the use of major procedures among the elderly
Racial trends in the use of major procedures among the elderly
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DOI：
10.1056/nejmsa050672
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发表时间：
2005-08-18
影响因子：
158.5
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Jha, AK;Fisher, ES;Epstein, AM
背景：众所周知，不同种族的患者在主要手术的使用上存在差异。无论是国家和地方的举措，以减少这些差异已经成功unknow.Methods：我们研究了数据的男性和女性参加医疗保险从1992年到2001年的年年龄标准化率收到9个外科手术之前显示有差异的速度，他们在黑人患者和白色患者。我们还检查了数据，根据医院转诊区域的9个程序：冠状动脉旁路移植术（CABG），颈动脉内膜切除术，全髋关节置换术。结果：在全国范围内，在1992年，收到的所有程序检查的比率高于白色患者比黑人患者。在1992年至2001年期间，9种手术中有5种手术的白人和黑人之间的比率差异显著增加，3种手术保持不变，1种手术显著缩小。我们调查了158个医院转诊地区（79个黑人男性和白色男性医院转诊地区，79个黑人女性和白色女性医院转诊地区）的CABG、颈动脉内膜切除术和全髋关节置换术的比率，每种手术都有足够的人数。我们发现，在20世纪90年代初，在每个医院转诊地区，白人接受这些手术的比例都高于黑人。到2001年，在22个医院转诊区，白人和黑人（包括男性和女性）在这些程序的比率上的差异显著缩小，在42个医院转诊区显著扩大，在其余医院转诊区没有显著变化。在研究期间结束时，我们发现没有医院转诊的地区，其中白人和黑人之间的差异率被消除男性或女性关于任何这三个procedure.Conclusions：对于20世纪90年代的十年，我们没有发现任何证据，无论是国家或地方，努力消除种族差异，在使用高成本的外科手术是成功的。
Background: Differences in the use of major procedures according to patients' race are well known. Whether national and local initiatives to reduce these differences have been successful is unknown.Methods: We examined data for men and women enrolled in Medicare from 1992 through 2001 on annual age-standardized rates of receipt of nine surgical procedures previously shown to have disparities in the rates at which they were performed in black patients and in white patients. We also examined data according to hospital-referral region for three of the nine procedures: coronary-artery bypass grafting (CABG), carotid endarterectomy, and total hip replacement.Results: Nationally, in 1992, the rates of receipt for all the procedures examined were higher among white patients than among black patients. The difference between the rates among whites and blacks increased significantly between 1992 and 2001 for five of the nine procedures, remained unchanged for three procedures, and narrowed significantly for one procedure. We examined rates of CABG, carotid endarterectomy, and total hip replacement in 158 hospital-referral regions (79 hospital-referral regions for black men and white men and 79 for black women and white women) with an adequate number of persons for each procedure. We found that in the early 1990s, whites had higher rates for these procedures than blacks in every hospital-referral region. By 2001, the difference between whites and blacks (both men and women) in the rates of these procedures narrowed significantly in 22 hospital-referral regions, widened significantly in 42, and were not significantly changed in the remaining hospital-referral regions. At the end of the study period, we found no hospital-referral region in which the difference in rates between whites and blacks was eliminated for men or women with regard to any of these three procedures.Conclusions: For the decade of the 1990s, we found no evidence, either nationally or locally, that efforts to eliminate racial disparities in the use of high-cost surgical procedures were successful.