Association of Socioeconomic Disadvantage With Mortality and Readmissions Among Older Adults Hospitalized for Pulmonary Embolism in the United States.
Association of Socioeconomic Disadvantage With Mortality and Readmissions Among Older Adults Hospitalized for Pulmonary Embolism in the United States.
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DOI：
10.1161/jaha.121.021117
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发表时间：
2021-07-06
影响因子：
5.4
通讯作者：
Goldhaber SZ
中科院分区：
文献类型：
--
作者：
Wadhera RK;Secemsky EA;Wang Y;Yeh RW;Goldhaber SZ
在美国，参加 Medicare 的老年人因肺栓塞 (PE) 住院的人数不断增加。尽管减少健康差异的努力有所加强，但仍不清楚因肺栓塞住院的社会经济弱势群体和非弱势医疗保险受益人之间的临床结果是否存在差异。在这项研究中，2015 年 10 月至 2017 年 1 月期间，有 53,386 名年龄≥65 岁的医疗保险按服务收费受益人因肺栓塞住院。其中，5494 人 (10.3%) 处于社会经济弱势地位，47 892 人 (89.7%) 处于非弱势地位。社会经济弱势成年人与非弱势成年人的年龄相似（77.1 比 77.0），更有可能是女性（68.5% 比 54.2%），接受先进治疗的可能性较小（11.0% 比 12.1%）。调整人口统计数据后，弱势成年人和非弱势成年人的 90 天全因死亡率相似。相比之下，社会经济地位较差的成年人的 1 年死亡率较高（风险比 [HR]，1.16；95% CI，1.10-1.22），尽管在对合并症和 PE 严重程度进行额外调整后，这些差异部分减弱（HR，1.09；95% CI，1.02-1.16）。社会经济弱势患者的风险调整后 30 天和 90 天全因再入院率明显较高（30 天 HR，1.14 [95% CI，1.06–1.22]；90 天 HR，1.18 [95% CI，1.12–1.25]）。此外，社会经济地位较差的患者中，因肺栓塞、深静脉血栓形成和/或出血而导致的 90 天再入院率较高（HR，1.16；95% CI，1.02-1.32）。与非弱势群体相比，因 PE 住院的社会经济弱势老年人的 1 年死亡率更高。近三分之一的社会经济弱势老年人因肺栓塞住院 90 天内再次入院。需要有针对性的策略来改善对这一弱势群体的过渡和门诊护理。
In the United States, hospitalizations for pulmonary embolism (PE) are increasing among older adults insured by Medicare. Although efforts to reduce health disparities have intensified, it remains unclear whether clinical outcomes differ between socioeconomically disadvantaged and nondisadvantaged Medicare beneficiaries hospitalized with PE. In this study, there were 53 386 Medicare fee‐for‐service beneficiaries age ≥65 years hospitalized for PE between October 2015 and January 2017. Of these, 5494 (10.3%) were socioeconomically disadvantaged and 47 892 (89.7%) were nondisadvantaged. Socioeconomically disadvantaged adults were of similar age as nondisadvantaged adults (77.1 versus 77.0), more likely to be female (68.5% versus 54.2%), and less likely to receive advanced therapies (11.0% versus 12.1%). After adjustment for demographics, 90‐day all‐cause mortality rates were similar between disadvantaged and nondisadvantaged adults. In contrast, 1‐year mortality rates were higher among socioeconomically disadvantaged adults (hazard ratio [HR], 1.16; 95% CI, 1.10–1.22), although these differences were partially attenuated after additional adjustments for comorbidities and PE severity (HR, 1.09; 95% CI, 1.02–1.16). Risk‐adjusted 30‐day and 90‐day all‐cause readmission rates were substantially higher among socioeconomically disadvantaged patients (30‐day HR, 1.14 [95% CI, 1.06–1.22]; 90‐day HR, 1.18 [95% CI, 1.12–1.25]). In addition, 90‐day readmissions attributed to PE, deep vein thrombosis, and/or bleeding were higher among socioeconomically disadvantaged patients (HR, 1.16; 95% CI, 1.02–1.32). Socioeconomically disadvantaged older adults hospitalized with PE have higher 1‐year mortality rates compared with their nondisadvantaged counterparts. Nearly 1 in 3 socioeconomically disadvantaged older adults was readmitted within 90 days of a hospitalization for PE. Targeted strategies are needed to improve transitional and ambulatory care for this vulnerable population.