Racial variation in the use of coronary-revascularization procedures - Are the differences real? Do they matter?
Racial variation in the use of coronary-revascularization procedures - Are the differences real? Do they matter?
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DOI：
10.1056/nejm199702133360706
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发表时间：
1997-02-13
影响因子：
158.5
通讯作者：
Mark, DB
中科院分区：
文献类型：
--
作者：
Peterson, ED;Shaw, LK;Mark, DB
背景研究报告称，黑人比白人更少接受冠状动脉血运重建手术，但尚不清楚这些患者的临床特征是导致这些差异的原因，还是表明黑人对冠状动脉重建程序的使用不足或白人过度使用这些程序。方法在杜克大学对12,402名冠心病患者(其中10.3%是黑人)进行的一项研究中，我们计算了黑人和白人在心导管术后进行血管成形术和搭桥手术的未调整和调整后的比率。我们还检查了根据疾病的严重程度、心绞痛状态和血运重建的估计生存益处对患者进行分层后的治疗模式。最后，我们比较了黑人和白人的五年存活率。结果在调整了疾病的严重性和其他特征后，黑人接受血管成形术的可能性比白人低13%，接受搭桥手术的可能性低32%。接受这些手术的调整后的黑人和白人的优势比分别为0.87(95%可信区间，0.73至1.03)和0.68(95%可信区间，0.56至0.82)。在有严重心绞痛症状的人群中，搭桥手术率的种族差异仍然存在(31%的黑人接受了手术，而白人为45%；P
Background Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites.Methods In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites.Results After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) and 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. The racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites; P