Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals.
Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals.
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DOI：
10.1007/s00455-018-9882-y
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发表时间：
2018-10
期刊：
影响因子：
2.6
通讯作者：
Gottesman RF
中科院分区：
文献类型：
--
作者：
Faigle R;Cooper LA;Gottesman RF
我们试图确定卒中后经皮内镜下胃造口术（PEG）置管对种族差异的个体和系统贡献。缺血性卒中入院是从2007年至2011年的全国住院患者样本中确定的。根据少数民族/种族卒中患者的百分比对医院进行分类（<25%的少数民族/种族[“白人医院”]，25-50%的少数民族/种族[“种族融合医院”]，或>50%的少数民族/种族[“少数民族服务医院”]）。使用逻辑回归评价不同医院分层内和不同医院分层之间种族/人种与PEG使用之间的相关性。在246，825例卒中住院患者中，在少数民族服务医院接受治疗的患者与在白人占多数的医院接受治疗的患者相比，PEG的几率更高，无论个体患者种族如何（调整后的比值比[OR] 1.24，95%CI 1.12-1.38）。在任何医院分层中，少数民族/种族的PEG几率都高于白人;然而，这种差异在白人占多数的医院中最大（OR 1.62，95% CI 1.48-1.76），在少数民族服务的医院中最小（OR 1.22，95% CI 1.11-1.33;相互作用p <0.001）。在任何医院分层中，少数民族/种族患者发生PEG的几率相似，而与多数白色医院相比，种族整合和少数民族服务的白色患者发生PEG的几率增加（与白人占多数的医院相比，种族融合的OR 1.28，95%CI 1.15-1.43，少数民族服务的OR 1.39，95%CI 1.23-1.57，趋势p <0.001）。与白人占多数的医院相比，少数民族医院缺血性卒中后PEG的可能性增加。与多数白色医院相比，少数族裔服务的白色患者发生PEG的几率更高，表明不同医院的PEG放置存在系统差异。
We sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (<25% ethnic/racial minorities [“majority-white hospitals”], 25–50% ethnic/racial minorities [“racially integrated hospitals”], or >50% ethnic/racial minorities [“minority-serving hospitals”]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospitals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12–1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majority-white hospitals (OR 1.62, 95% CI 1.48–1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11–1.33; p for interaction <0.001). Ethnic/racial minority patients had similar odds of PEG in any hospital strata, while white patients had increasing odds of PEG in racially integrated and minority-serving compared to majority-white hospitals (OR 1.28, 95% CI 1.15–1.43 in racially integrated, and OR1.39, 95% CI 1.23–1.57 in minority-serving, compared to majority-white hospitals, p for trend <0.001). The likelihood of PEG after ischemic stroke was increased in minority-serving compared to majority-white hospitals. White patients had higher odds of PEG in minority-serving compared to majority-white hospitals, indicating a systemic difference in PEG placement across hospitals.
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影响因子：
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作者：
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