Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care.
Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care.
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DOI：
10.1161/circulationaha.113.005231
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发表时间：
2014-06-17
期刊：
影响因子：
37.8
通讯作者：
Normand SL
中科院分区：
文献类型：
--
作者：
Albert MA;Ayanian JZ;Silbaugh TS;Lovett A;Resnic F;Jacobs A;Normand SL
有保险的成年人比无保险的成年人更频繁地接受侵入性心血管手术。我们研究了马萨诸塞州医疗改革对冠状动脉血运重建术的使用、住院和1年死亡率的影响，这些影响按种族/民族、教育和性别进行。利用医院索赔数据，我们比较了马萨诸塞州21-64岁住院的主要出院诊断为缺血性心脏病的居民中，不同种族/民族、教育和性别的冠状动脉血运重建率[冠状动脉旁路移植术或经皮冠状动脉介入治疗]和住院死亡率的差异。（2004年11月1日至2006年7月31日）和改革后（2006年12月1日至2008年9月30日）;计算接受血运重建的患者的1年死亡率。经调整的逻辑回归评估了24，216例改革前出院和20，721例改革后出院。在改革前，黑人接受冠状动脉血运重建的几率比白人低30%。与白人相比，在改革后时期，黑人（OR=0.73，95%CI 0.63-0.84）和西班牙裔（OR= 0.84，95%CI 0.74-0.97）接受冠状动脉血运重建的可能性较低，亚洲人（OR=1.29，95%CI 1.01-1.65）接受冠状动脉血运重建的可能性较高。生活在教育程度较高的社区、男性和有私人保险的人更有可能在改革前后接受冠状动脉血运重建。与改革前相比，在改革后时期，生活在教育程度较低社区的患者的住院死亡率的调整后几率较高。在改革前或改革后，没有观察到血运重建患者的1年死亡率在人种/种族、教育或性别方面的差异。减少接受冠状动脉血运重建手术的保险障碍尚未消除接受这些手术方面预先存在的人口和教育差异。
Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of Massachusetts’s healthcare reform on use of coronary revascularization procedures, in–hospital and 1-year mortality by race/ethnicity, education, and sex. Using hospital claims data, we compared differences in coronary revascularization rates [coronary artery bypass grafting or percutaneous coronary intervention] and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents age 21–64 hospitalized with a principal discharge diagnosis of ischemic heart disease pre (November 1, 2004 to July 31, 2006) and post (December 1, 2006 to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted-logistic regression assessed 24,216 discharges pre-reform and 20,721 discharges post-reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the pre-reform period. Compared to whites in the post-reform period, blacks (OR=0.73, 95%CI 0.63–0.84) and Hispanics (OR= 0.84, 95%CI 0.74–0.97) were less likely and Asians (OR=1.29, 95%CI 1.01–1.65) more likely to receive coronary revascularization. Patients living in more educated communities, males, and persons with private insurance were more likely to receive coronary revascularization pre and post-reform. Compared to pre-reform, the adjusted odds of in-hospital mortality were higher in patients living in less educated communities in the post-reform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed pre- or post-reform. Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated pre-existing demographic and educational disparities in access to these procedures.