The COVID-19 Pandemic and Associated Inequities in Acute Myocardial Infarction Treatment and Outcomes.
The COVID-19 Pandemic and Associated Inequities in Acute Myocardial Infarction Treatment and Outcomes.
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DOI：
10.1001/jamanetworkopen.2023.30327
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Dick, Andrew W.
中科院分区：
文献类型：
--
作者：
Glance, Laurent G.;Joynt Maddox, Karen E.;Shang, Jingjing;Stone, Patricia W.;Lustik, Stewart J.;Knight, Peter W.;Dick, Andrew W.
这项横断面研究调查了新冠肺炎大流行与急性心肌梗死患者的治疗和结果差异之间的关系。新冠肺炎大流行是否与因急性心肌梗死住院的联邦医疗保险患者在治疗和预后方面的差异增加有关？在这项对1例 319例 273例急性心肌梗死住院患者的横断面研究中，新冠肺炎大流行与非ST段抬高心肌梗死患者的死亡率和非家庭性出院患者的死亡率显著增加以及血管重建的减少有关，而与ST段抬高心肌梗死患者无关。这些发现并不因患者种族或民族而有显著差异。这项研究发现，虽然大流行与急性心肌梗死患者的治疗和预后较差有关，但种族和民族相关的不平等并未显著增加。新冠肺炎的大流行打乱了对急性心肌梗死等紧急情况的常规护理。了解在大流行期间，与白人相比，患有急性心肌梗死的黑人和西班牙裔患者的不良结局是否有更大的增加，这具有重要的公平意义。为了调查新冠肺炎大流行是否与因急性心肌梗死住院的联邦医疗保险患者在治疗和预后方面存在更大差异有关。这项横断面研究使用了2016年1月至2020年11月期间住院的急性心肌梗死患者的医疗保险数据。患者被归类为西班牙裔、非西班牙裔黑人和非西班牙裔白人。使用中断的时间序列来评估种族和民族之间的关联以及作为新冠肺炎住院患者比例的函数的结果。对2022年10月至2023年6月的数据进行了分析。主要接触到的是一家医院每周住院患者中新冠肺炎患者的比例，作为疫情期间护理中断的指标。血运重建、30天死亡率、30天再入院和非家庭出院。共纳入1例 319 273例急性心肌梗死患者(女性579例， 817例(44.0%)；黑人122例， 972例[9.3%]；西班牙裔117例， 668例；白人1例， 078例， 633例[81.8%]；平均年龄77[8.4]岁)。对于非ST段抬高的MI患者，调整后的死亡率和非家庭性出院的优势分别增加了51%(调整后的优势比，1.51；95%CI，1.29-1.76；P <； .001)和32%(调整后的优势比，1.32；95%CI，1.15-1.52；P <； .001)，血运重建的优势降低了27%(调整后的优势比，0.73；95%CI，0.64-0.83；P <；在新冠肺炎负担较高的住院周内(>；30%)与疫情前住院的患者之间的对比研究( .001)。与白人相比，患有非ST段抬高心肌梗死的黑人患者的住院负担每增加10%，其死亡率在临床上就会显著增加7%(AOR1.07；95%CI，1.00-1.15；P = .04)，但再入院或非住院出院的情况没有增加，血管再造率也没有下降。根据医院新冠肺炎的负担，与患有非STEMI的白人患者相比，西班牙裔患者的不良结局没有差别的增加。住院新冠肺炎负担的增加与结果的改变或STEMI中血管重建的使用无关，总体上或按种族或民族分组。这项研究发现，虽然医院新冠肺炎的负担与非STEMI的较差治疗和结果相关，但在大流行期间，种族和民族相关的不平等并未显著增加。这些发现表明，当医院新冠肺炎的负担大幅增加时，需要做出更多努力来减轻入院的急性心肌梗死患者与新冠肺炎大流行相关的后果。
This cross-sectional study investigates the association of the COVID-19 pandemic with treatment and outcome disparities among patients with acute myocardial infarction. Was the COVID-19 pandemic associated with increases in disparities in treatment and outcomes among Medicare patients hospitalized with acute myocardial infarction (AMI)? In this cross-sectional study of 1 319 273 AMI admissions, the COVID-19 pandemic was associated with significant increases in mortality and nonhome discharges and reduction in revascularization for patients admitted with non–ST segment elevation MI but not patients admitted with ST-segment elevation MI. These findings did not differ significantly by patient race or ethnicity. This study found that while the pandemic was associated with worse treatment and outcomes in patients with AMI, race and ethnicity–associated inequities did not increase significantly. The COVID-19 pandemic disrupted usual care for emergent conditions, such as acute myocardial infarction (AMI). Understanding whether Black and Hispanic individuals experiencing AMI had greater increases in poor outcomes compared with White individuals during the pandemic has important equity implications. To investigate whether the COVID-19 pandemic was associated with increased disparities in treatment and outcomes among Medicare patients hospitalized with AMI. This cross-sectional study used Medicare data for patients hospitalized with AMI between January 2016 and November 2020. Patients were categorized as Hispanic, non-Hispanic Black, and non-Hispanic White. The association between race and ethnicity and outcomes as a function of the proportion of hospitalized patients with COVID-19 was evaluated using interrupted time series. Data were analyzed from October 2022 to June 2023. The main exposure was a hospital’s proportion of hospitalized patients with COVID-19 on a weekly basis as a proxy for care disruption during the pandemic. Revascularization, 30-day mortality, 30-day readmission, and nonhome discharges. A total of 1 319 273 admissions for AMI (579 817 females [44.0%]; 122 972 Black [9.3%], 117 668 Hispanic [8.9%], and 1 078 633 White [81.8%]; mean [SD] age, 77 [8.4] years) were included. For patients with non–ST segment elevation MI (NSTEMI) overall, the adjusted odds of mortality and nonhome discharges increased by 51% (adjusted odds ratio [aOR], 1.51; 95% CI, 1.29-1.76; P < .001) and 32% (aOR, 1.32; 95% CI, 1.15-1.52; P < .001), respectively, and the odds of revascularization decreased by 27% (aOR, 0.73; 95% CI, 0.64-0.83; P < .001) among patients hospitalized during weeks with a high hospital COVID-19 burden (>30%) vs patients hospitalized prior to the pandemic. Black individuals with NSTEMI experienced a clinically insignificant 7% greater increase in the odds of mortality (aOR, 1.07; 95% CI, 1.00-1.15; P = .04) for each 10% increase in the COVID-19 hospital burden but no increases in readmissions or nonhome discharges or reductions in revascularization rates compared with White individuals. There were no differential increases in adverse outcomes among Hispanic compared with White patients with NSTEMI based on hospital COVID-19 burden. Increases in hospital COVID-19 burden were not associated with changes in outcomes or the use of revascularization in STEMI overall or by racial or ethnic group. This study found that while hospital COVID-19 burden was associated with worse treatment and outcomes for NSTEMI, race and ethnicity–associated inequities did not increase significantly during the pandemic. These findings suggest the need for additional efforts to mitigate outcomes associated with the COVID-19 pandemic for patients admitted with AMI when the hospital COVID-19 burden is substantially increased.
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影响因子：
37.8
作者：
Churchwell, Keith;Elkind, Mitchell S. V.;Williams, Olajide
通讯作者：
Williams, Olajide
DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
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通讯作者：
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作者：
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影响因子：
158.5
作者：
Jha, AK;Fisher, ES;Epstein, AM
通讯作者：
Epstein, AM
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影响因子：
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作者：
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通讯作者：
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