Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center
Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center
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DOI：
10.1161/circheartfailure.119.006214
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发表时间：
2019-11-01
影响因子：
9.7
通讯作者：
Zon, Rebecca
中科院分区：
文献类型：
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作者：
Eberly, Lauren A.;Richterman, Aaron;Zon, Rebecca
背景：心力衰竭（HF）患者的种族不平等已被广泛记录。在入院期间接受心脏病护理的HF患者有更好的结局。目前还不清楚是否有不同的心脏病或一般医学服务的种族入院。本研究探讨了种族和入院服务之间的关系，及其对30天再入院率和死亡率的影响。我们从2008年9月至2017年11月在一个大型城市学术转诊中心进行了一项回顾性队列研究，研究对象是所有自我转诊到急诊科并入院接受心脏病学或全科医学服务的主要诊断为HF的患者，自称是白色黑人或拉丁裔的人我们使用多变量广义估计方程模型来评估种族和心脏病服务之间的关系。我们使用考克斯回归来评估种族、入院服务和30天再入院与死亡率之间的关系。结果如下：在1967例独特患者（66.7%白色、23.6%黑人和9.7%拉丁裔）中，黑人和拉丁裔患者的心脏病服务入院率低于白色患者（黑人校正率比为0.91; 95%CI为0.84-0.98;拉丁裔校正率比为0.83; 95%CI为0.72-0.97）。女性性别和年龄>75岁也与较低的心脏病服务入院率独立相关。心脏病学服务的入院与30天内再入院率的降低独立相关，与种族无关。结论：黑人和拉丁裔患者不太可能因HF护理而入院。这种不平等可能在一定程度上导致HF结局中的种族不平等。
Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.