Hispanic/Latino-Serving Hospitals Provide Less Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest.
Hispanic/Latino-Serving Hospitals Provide Less Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest.
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DOI：
10.1161/jaha.121.023934
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发表时间：
2021-12-21
影响因子：
5.4
通讯作者：
Badjatia, Neeraj
中科院分区：
文献类型：
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作者：
Morris, Nicholas A.;Mazzeffi, Michael;McArdle, Patrick;May, Teresa L.;Waldrop, Greer;Perman, Sarah M.;Burke, James F.;Bradley, Steven M.;Agarwal, Sachin;Figueroa, Jose F.;Badjatia, Neeraj
院外心脏骤停（OHCA）后的结局存在差异，但在停搏后提供目标温度管理（TTM）方面是否存在种族和民族差异尚不清楚。我们对前瞻性收集的患者队列进行了回顾性分析，这些患者在OHCA后存活至入院，来自心脏骤停登记研究以提高生存率，其集水区占2013 - 2019年美国的约50%。我们的主要暴露是种族/民族，主要结局是TTM的使用。我们建立了一个混合效应模型，将逮捕状态和入院状态建模为随机截取以解释聚类。在96，695例患者中（24.6%黑人，8.0%西班牙裔/拉丁裔，63.4%白色），在OHCA后，西班牙裔/拉丁裔患者接受TTM的百分比低于黑人或白色患者（37.5% vs. 45.0% vs. 43.3%，P < .001）。在混合效应模型中，黑人患者（比值比[OR] 1.153，95%置信区间[CI] 1.102 - 1.207，P < .001）和西班牙裔/拉丁裔患者（OR 1.086，95% CI 1.017 - 1.159，P < .001）接受TTM的可能性略高于白色患者，可能是由于入院时神经系统状态较差。我们确实发现了社区水平的差异，因为西班牙裔/拉丁裔服务医院（定义为照顾西班牙裔/拉丁裔患者比例最高的前10%医院）提供的TTM较少（OR 0.587，95%CI 0.474至0.742，P < .001）。令人欣慰的是，我们没有发现证据的医院内或人际种族或民族的差异，在提供TTM。然而，我们确实发现了医院间、社区水平的差异。在OHCA之后，西班牙裔/拉丁裔服务医院提供的指南推荐TTM较少。
Variation exists in outcomes following out‐of‐hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post‐arrest provision of targeted temperature management (TTM) is unknown. We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013‐2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed‐effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed‐effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102‐1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017‐1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino‐serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter‐hospital, community level disparity. Hispanic/Latino‐serving hospitals provided less guideline‐recommended TTM after OHCA.