Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.
Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.
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综合医疗保健系统中医疗保险受益人超声心动图的种族，性别和年龄差异。
DOI：
10.1136/heartjnl-2021-319951
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发表时间：
2022-05-25
期刊：
影响因子：
5.7
通讯作者：
Strom, Jordan B.
中科院分区：
文献类型：
--
作者：
Hyland, Patrick M.;Xu, Jiaman;Shen, Changyu;Markson, Lawrence J.;Manning, Warren J.;Strom, Jordan B.
目的：确定几十年来经胸超声心动图(TTE)检查中潜在的种族、性别和年龄差异。来自单个集成医疗系统内5个学术和社区站点的TTE报告与100%联邦医疗保险服务收费索赔相关联，2005年1月1日至2017年12月31日。根据基线年龄、性别、种族和合并≥2 TTE的个体，使用多变量泊松回归来估计TTE指数后的调整后的TTE利用率。非白人种族被定义为黑人、亚洲人、北美原住民、西班牙人或其他使用联邦医疗保险分配的种族类别的类别。共有15,870人(50.1%女性，平均72.2±12.7岁)在平均4.9(2.4-8.5)年的随访期内接受了63,535次TTE(范围2-55次/人)。在TTE指数之后，TTE使用的中位数为0.72 Ttes/人/年(IQR 0.43-1.33；范围0.12-26.76)。TTE的使用率较低的是年龄较大的老年人(RR为0.91，95%CI为0.89-0.92，P<；0.001)、女性(RR为0.97，95%CI为0.95-0.99，P<；0.001)和非白人(RR为0.95，95%CI为0.93-0.97，P<；0.001)。黑人女性的TTE相对使用率最低(RR0.92，95%CI0.88-0.95，p<；0.001)。多变量调整后与TTE使用量增加相关的唯一临床情况是心力衰竭(RR 1.04，95%CI 1.00-1.08，p=0.04)和慢性阻塞性肺疾病(RR 1.05，95%CI 1.00-1.10，p=0.04)。在单个大型医疗系统中拥有多个TTE的联邦医疗保险受益人中，TTE指数后TTE使用的中位数为0.72 Tte/人/年，尽管差异很大。经合并症调整后，女性、非白人和高龄与TTE利用率降低有关。
To identify potential race, sex, and age disparities in performance of transthoracic echocardiography (TTE) over several decades. TTE reports from 5 academic and community sites within a single integrated healthcare system were linked to 100% Medicare Fee-for-service claims, 1/1/2005 – 12/31/2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilization after the index TTE according to baseline age, sex, race, and comorbidities amongst individuals with ≥ 2 TTEs. Non-white race was defined as Black, Asian, North American Native, Hispanic, or other categories using Medicare-assigned race categories. A total of 15,870 individuals (50.1% female, mean 72.2 ± 12.7 years) underwent a total of 63,535 TTEs (range 2 – 55/person) over a median (IQR) follow up time of 4.9 (2.4 – 8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43 – 1.33; range 0.12 – 26.76). TTE use was lower in older individuals (RR for 10-year increase in age, 0.91, 95% CI 0.89 – 0.92, p < 0.001), females (RR 0.97, 95% CI 0.95 – 0.99, p < 0.001), and non-whites (RR 0.95, 95% CI 0.93 – 0.97, p < 0.001). Black females in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 – 0.95, p < 0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00-1.08, p = 0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00-1.10, p = 0.04). Among Medicare beneficiaries with multiple TTEs in a single, large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year though varied widely. Adjusted for comorbidities, female sex, non-white race, and advancing age were associated with decreased TTE utilization.
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