Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.
Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.
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DOI：
10.1161/jaha.123.030138
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发表时间：
2023-10-03
影响因子：
5.4
通讯作者：
中科院分区：
文献类型：
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在全国范围内，种族居住隔离对初次复苏后院外心脏骤停结果的影响仍然知之甚少。我们试图描述邮政编码水平的种族和经济居住隔离措施与医疗保险受益人院外心脏骤停后的长期生存和再入院之间的关系。在这项使用医疗保险索赔数据的回顾性队列研究中，我们的主要预测指标是极端集中指数，这是衡量种族和经济隔离的一种指标。主要结局是3年内死亡和再入院。在调整受益人人口统计、治疗医院特征和指数医院程序的同时，我们估计了所有三种极端情况下浓度指数的风险比（hr）。在完全调整的长期生存模型中，我们发现，与隔离程度较高的白人社区和收入较高的邮政编码相比，居住在隔离程度较高的黑人社区和收入较低的邮政编码的受益人的死亡风险和再入院风险在所有三个极端测量浓度指数（种族：HR， 0.87 [95% CI, 0.81-0.93]；收入：HR， 0.75 [95% CI, 0.69-0.78]；种族+收入：HR， 0.77 [95% CI, 0.72-0.82]）中都有所降低。我们发现，当使用有效的种族和经济隔离措施时，与居住在隔离程度较高的白人社区和收入较高的邮政编码的黑人社区和收入较低的邮政编码的黑人社区相比，居住在隔离程度较高的白人社区和收入较高的邮政编码的白人社区的死亡风险和再入院风险降低。虽然因果途径和机制尚不清楚，但院外心脏骤停后结果的差异与种族和财富的结构成分有关，并持续到出院后3年。
The national impact of racial residential segregation on out‐of‐hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long‐term survival and readmissions after out‐of‐hospital cardiac arrest among Medicare beneficiaries. In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation. The primary outcomes were death up to 3 years and readmissions. We estimated hazard ratios (HRs) across all 3 types of index of concentration at the extremes measures for each outcome while adjusting for beneficiary demographics, treating hospital characteristics, and index hospital procedures. In fully adjusted models for long‐term survival, we found a decreased hazard of death and risk of readmission for beneficiaries residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes across all 3 indices of concentration at the extremes measures (race: HR, 0.87 [95% CI, 0.81–0.93]; income: HR, 0.75 [95% CI, 0.69–0.78]; and race+income: HR, 0.77 [95% CI, 0.72–0.82]). We found a decreased hazard of death and risk for readmission for those residing in the more segregated White communities and higher‐income ZIP codes compared with the more segregated Black communities and lower‐income ZIP codes when using validated measures of racial and economic segregation. Although causal pathways and mechanisms remain unclear, disparities in outcomes after out‐of‐hospital cardiac arrest are associated with the structural components of race and wealth and persist up to 3 years after discharge.