Impact of Race on the In-Hospital Quality of Care Among Young Adults With Acute Myocardial Infarction.
Impact of Race on the In-Hospital Quality of Care Among Young Adults With Acute Myocardial Infarction.
复制标题
DOI：
10.1161/jaha.121.021408
复制
发表时间：
2021-09-07
影响因子：
5.4
通讯作者：
Dreyer RP
中科院分区：
文献类型：
--
作者：
Raparelli V;Benea D;Nunez Smith M;Behlouli H;Murphy TE;D'Onofrio G;Pilote L;Dreyer RP
种族对患有急性心肌梗死（AMI）的年轻人（≤55岁）的医院护理质量的影响程度在很大程度上是未知的。我们研究了院内AMI护理质量的种族差异及其对1年心脏再入院的影响。我们使用的数据来自处女座（恢复变化：性别对年轻AMI患者结局的作用）研究，该研究招募了美国年轻的AMI黑人和白人成人（2008-2012）。计算医院内护理质量评分（QCS）（标准AMI质量指标除以患者符合条件的总数）。进行多变量逻辑回归以确定与最低QCS分位数相关的因素，包括种族和健康的社会决定因素之间的相互作用。在2846名患有AMI的年轻人中（中位48岁[四分位数范围44-52]，67.4%为女性，18.8%为黑人），黑人个体，尤其是女性，表现出更高的心脏危险因素和健康的社会决定因素的患病率，并且比白人更容易经历非st段抬高型心肌梗死。黑人个体比白人个体更有可能处于最低QCS不育区（40.8%比34.7%，P=0.003）。黑人种族与低QCS之间的关联（优势比[OR]， 1.25; 95% CI, 1.02-1.54）通过调整混杂因素而减弱。就业与较好的QCS独立相关，尤其是在黑人参与者中（OR, 0.76; 95% CI, 0.62-0.92； P交互作用=0.02）。黑人1年心脏再入院率更高（29.9% vs 20.0%； P<0.0001）。黑人AMI患者的院内护理质量较低，心脏再入院率高于白人患者。黑人失业后的医疗质量较低，这凸显了种族和健康的社会决定因素的交集。
The extent to which race influences in‐hospital quality of care for young adults (≤55 years) with acute myocardial infarction (AMI) is largely unknown. We examined racial disparities in in‐hospital quality of AMI care and their impact on 1‐year cardiac readmission. We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study enrolling young Black and White US adults with AMI (2008–2012). An in‐hospital quality of care score (QCS) was computed (standard AMI quality indicators divided by the total a patient is eligible for). Multivariable logistic regression was performed to identify factors associated with the lowest QCS tertile, including interactions between race and social determinants of health. Among 2846 young adults with AMI (median 48 years [interquartile range 44–52], 67.4% women, 18.8% Black race), Black individuals, especially women, exhibited a higher prevalence of cardiac risk factors and social determinants of health and were more likely to experience a non–ST‐segment–elevation myocardial infarction than White individuals. Black individuals were more likely in the lowest QCS tertile than White individuals (40.8% versus 34.7%; P=0.003). The association between Black race and low QCS (odds ratio [OR], 1.25; 95% CI, 1.02–1.54) was attenuated by adjustment for confounders. Employment was independently associated with better QCS, especially among Black participants (OR, 0.76; 95% CI, 0.62–0.92; P‐interaction=0.02). Black individuals experienced a higher rate of 1‐year cardiac readmission (29.9% versus 20.0%; P<0.0001). Black individuals with AMI received lower in‐hospital quality of care and exhibited a higher rate of cardiac readmissions than White individuals. Black individuals had a lower quality of care if unemployed, highlighting the intersection of race and social determinants of health.