Epidemiology of age-, sex-, and race-specific hospitalizations for abdominal aortic aneurysms highlights gaps in current screening recommendations.
Epidemiology of age-, sex-, and race-specific hospitalizations for abdominal aortic aneurysms highlights gaps in current screening recommendations.
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DOI：
10.1016/j.jvs.2022.02.058
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发表时间：
2022-11
影响因子：
4.3
通讯作者：
Tzeng, Edith
中科院分区：
文献类型：
--
作者：
Li, Shimena R.;Reitz, Katherine M.;Kennedy, Jason;Gabriel, Lucine;Phillips, Amanda R.;Shireman, Paula K.;Eslami, Mohammad H.;Tzeng, Edith
在已知风险因素特异性筛查指导下检测和选择性修复腹主动脉瘤（AAA）可降低AAA相关死亡率。然而，AAA在女性和少数种族群体中的流行病学数据很少。我们确定了不同年龄、性别和种族的美国AAA住院的当代风险。使用国家住院患者样本和美国人口普查（2012-2018）数据量化AAA住院（≥18岁）的年龄、性别和种族特异性发生率和校正比值比（aOR）、相关风险因素和住院死亡率。相互作用项评价亚组。在研究期间的1，728，374，183名美国居民中，（51.3%女性; 78.4%白色，12.7%黑人，5.7%亚洲人），211，501，703人住院（年龄：57.56±0.04岁; 58.4%女性; 64.9%白色，14.3%黑人，2.5%亚洲人），其中291，850例为AAA患者（年龄，73.17±0.04岁; 22.6%女性; 81.8%白色，5.6%黑人，1.6%亚洲人）。估计每100，000名居民中有15.2（95%CI，15.1-15.3）和1.7（95%CI，1.7-1.7）例因完整（iAAA）和破裂（rAAA）AAA住院。16.2%的iAAA（83.8%男性; 79.1%白色）和18.4%的rAAA（86.4%男性; 75.0%白色）住院发生在<65岁的患者中。对于iAAA，女性（aOR，0.27 [95%CI，0.27-0.28]）与男性相比，黑人（0.47 [95%CI，0.45-0.49]）和亚洲人（0.86 [95%CI，0.83-0.93]）与白色人相比，住院aOR降低。对于rAAA，女性（0.33 [95%CI，0.32-0.36]）和黑人（0.52 [95%CI，0.46-0.58]）的aOR持续降低。虽然女性患者AAA住院率总体降低，但年龄较大、黑人或患有外周血管疾病（P-相互作用<0.001）的女性患者AAA住院率aOR相对增加。女性（aOR，1.54 [95%CI，1.38-1.70]），而非黑人或亚洲人种，与死亡率增加相关，iAAA（1.93 [95%CI，1.66-2.25]）比rAAA（1.29 [95%CI，1.13-1.48]; P-相互作用<0.001）更明显。我们证实，女性和少数种族群体的AAA住院调整后风险显著降低;然而，老龄化和共病外周血管疾病减少了这些差异。不同性别和种族的AAA住院风险差异突出了未来AAA研究中包容性的重要性。少数种族群体和女性AAA住院的风险较低;然而，随着年龄的增长，风险接近白色男性。作者建议在未来的AAA研究中必须包括种族和性别。
Detection and elective repair of abdominal aortic aneurysms (AAA) guided by known risk-factor specific screening decrease AAA-related mortality. However, minimal epidemiologic data exist for AAA in female persons and racial minority groups. We established the contemporary risk of US AAA hospitalization across age, sex, and race. National Inpatient Sample and US Census (2012–2018) data were used to quantify age-, sex-, and race-specific incidences and adjusted odds ratios (aOR) of AAA hospitalizations (≥18 years), associated risk factors, and in-hospital mortality. Interaction terms evaluated subgroups. Among 1,728,374,183 US residents during the study period (51.3% female; 78.4% White, 12.7% Black, 5.7% Asian), 211,501,703 were hospitalized (age, 57.56±0.04 years; 58.4% female; 64.9% White, 14.3% Black, 2.5% Asian) of which 291,850 were for AAA (age, 73.17±0.04 years; 22.6% female; 81.8% White, 5.6% Black, 1.6% Asian). An estimated 15.2 (95%CI, 15.1–15.3) and 1.7 (95%CI, 1.7–1.7) hospitalizations per 100,000 residents were for intact (iAAA) and ruptured (rAAA) AAA, respectively. 16.2% of iAAA (83.8% male; 79.1% White) and 18.4% of rAAA (86.4% male; 75.0% White) hospitalizations occurred in patients <65 years. For iAAA, female sex (aOR, 0.27 [95%CI, 0.27–0.28]) compared to male sex and both Black (0.47 [95%CI, 0.45–0.49]) and Asian (0.86 [95%CI, 0.83–0.93]) persons compared to White persons had reduced aOR for hospitalization. For rAAA, the reduced aOR persisted for female sex (0.33 [95%CI, 0.32–0.36]) and for Black persons (0.52 [95%CI, 0.46–0.58]). While female sex demonstrated an overall reduced odds of AAA hospitalization, female persons who were older, Black, or had peripheral vascular disease (P-interactions<0.001) had a relative increase in AAA hospitalization aOR. Female sex (aOR, 1.54 [95%CI, 1.38–1.70]), but not Black or Asian race, was associated with increased mortality which was more pronounced for iAAA (1.93 [95%CI, 1.66–2.25]) than rAAA (1.29 [95%CI, 1.13–1.48]; P-interaction<0.001). We confirmed a substantially decreased adjusted risk of AAA hospitalization for female sex and racial minority groups; however, aging and comorbid peripheral vascular disease reduced these differences. The disparate risk of AAA hospitalization by sex and race highlights the importance of inclusivity in future AAA studies. Racial minority groups and female persons have a lower risk of AAA hospitalization; however, the risk approaches that of White male persons as age increases. The authors suggest race and sex must be included in future AAA studies.
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影响因子：
--
作者：
Farjah, Farhood;Wood, Douglas E.;Flum, David R.
通讯作者：
Flum, David R.
影响因子：
39
作者：
McCaul, Kieran A.;Lawrence-Brown, Michael;Norman, Paul E.
通讯作者：
Norman, Paul E.
DOI：
10.1001/jama.2017.17653
发表时间：
2017-11-28
期刊：
JAMA
影响因子：
--
作者：
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通讯作者：
Krumholz HM
影响因子：
4.3
作者：
McPhee, James T.;Hill, Joshua S.;Eslami, Mohammad H.
通讯作者：
Eslami, Mohammad H.
影响因子：
5
作者：
Gold, Ellen B.;Crawford, Sybil L.;Harlow, Sioban D.
通讯作者：
Harlow, Sioban D.