In-hospital mortality rates from acute myocardial infarction by race in U.S. hospitals: findings from the National Hospital Discharge Survey.
In-hospital mortality rates from acute myocardial infarction by race in U.S. hospitals: findings from the National Hospital Discharge Survey.
复制标题
美国医院按种族划分的急性心肌梗塞住院死亡率：全国医院出院调查的结果。
DOI：
10.1161/01.cir.76.2.280
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发表时间：
1987
期刊：
影响因子：
37.8
通讯作者：
Cooper,R
中科院分区：
文献类型：
--
作者：
Roig,E;Castaner,A;Simmons,B;Patel,R;Ford,E;Cooper,R
在美国，年轻时黑人的冠状动脉疾病死亡率高于白人，70 岁以上死亡率则较低。决定年龄特定死亡率交叉的因素尚未阐明。从黑人群体中选择由于更容易患冠心病而病情较重的年轻人可能会留下相对更健康的老年人群。支持这一假设的部分证据表明，冠状动脉疾病在黑人群体中发病较早。我们检查了 1973 年至 1984 年全国医院出院调查的数据，以确定白人和非白人之间是否存在与年龄相关的病死率差异。对于 70 岁以下的非白人来说，每个 10 岁年龄组的院内病死率均高出 10% 至 70%，此时出现了交叉。与白人相比，非白人因心肌梗塞死亡的中位年龄大约年轻 5 岁。根据这些数据对全国心肌梗死住院率的估计同样表明，相对于记录的致命事件而言，非白人因冠状动脉疾病而获得的医疗保健少于白人。特定年龄的病死率趋势支持这样的假设：队列选择效应在一定程度上决定了冠状动脉疾病的黑人/白人差异。因此，黑人和白人人口的相对易感性不能通过年龄调整率来适当估计，而应在群体选择效应的框架内根据特定年龄进行检查。
Mortality rates in the United States from coronary artery disease are higher among blacks than whites at younger ages, with a crossover to lower rates above the age of 70. The factors that determine this crossover of age-specific death rates have not been elucidated. Selection from the black population of younger individuals who are sicker by virtue of being more coronary prone might leave a relatively healthier group of older persons. Support for this hypothesis would consist in part of evidence that coronary artery disease has an earlier onset in the black population. We examined data from the National Hospital Discharge Survey for the years 1973-1984 to determine if age-related differences in case-fatality rates existed between whites and nonwhites. In-hospital case fatality rates were 10% to 70% higher for each of the 10 year age groups for nonwhites up to age 70, at which time a crossover occurred. The median age at death from myocardial infarction was approximately 5 years younger in nonwhites compared with whites. National estimates of hospitalization rates for myocardial infarction from these data likewise suggest that nonwhites receive less health care for coronary artery disease than whites relative to recorded fatal events. The age-specific trends in case-fatality support the hypothesis that a cohort selection effect in part determines the black/white differentials in coronary artery disease. Relative susceptibility of the black and white population is thus not appropriately estimated by age-adjusted rates, but should be examined on an age-specific basis within the framework of selection effects on a cohort.