Racial and sex differences in refusal of coronary angiography
Racial and sex differences in refusal of coronary angiography
复制标题
DOI：
10.1016/s0002-9343(02)01221-4
复制
发表时间：
2002-08-15
影响因子：
5.9
通讯作者：
McClellan, M
中科院分区：
文献类型：
--
作者：
Heidenreich, PA;Shlipak, MG;McClellan, M
目得：确定老年急性心肌梗死患者拒绝冠状动脉造影术对种族和性别差异以及预后的影响。受试者和方法：我们纳入了1994年2月至1995年7月期间因接受冠状动脉造影而入院的医疗保险受益人患者。确定了在医院使用和拒绝冠状动脉造影，并根据患者、医院和医生的特征进行了调整。结果：在124，691例患者中，53，671例（43%）在住院期间接受了血管造影术，2881例（2.3%）拒绝接受。拒绝血管造影的患者更可能是女性（比值比[OR] = 1.37; 95%置信区间[CI]：1.23至1.53），黑人（OR = 1.26 vs.白人; 95% CI：1.02 - 1.56），年龄（OR = 2.25/10年增加; 95% CI：2.05 - 2.43）大于接受血管造影术的患者。黑人血管造影使用率（OR = 0.78; 95% CI：0.72 - 0.83）低于白人，女性血管造影使用率（OR = 0.83; 95% CI：0.80 - 0.86）低于男性。拒绝增加解释了6%（95% CI：-3%至15%）的白人和黑人之间的血管造影使用差异，以及16%（95% CI：10%至22%）的男性和女性之间的差异。在调整患者特征后，拒绝血管造影与I年生存率降低无关（OR = 0.99; 95%CI：0.82 - 1.20）。结论：在医疗保险受益人中，老年女性和黑人患者比男性和白色患者更可能拒绝血管造影。然而，患者拒绝是罕见的，仅占心肌梗死后血管造影术使用的种族和性别差异的一小部分。Am J Med.（C）2002，Excerpta Medica，Inc.
PURPOSE: To determine the effect of patient refusal on racial and sex differences in the use of coronary angiography and in outcomes among elderly patients with acute myocardial infarction. SUBJECTS AND METHODS: We included Medicare beneficiary patients admitted to hospitals performing coronary angiography from February 1994 through July 1995. In-hospital use and refusal of coronary angiography were determined, and adjusted for patient, hospital, and physician characteristics. RESULTS: Of 124,691 patients, 53,671 (43%) underwent angiography during hospitalization and 2881 (2.3%) refused. Patients refusing angiography were more likely to be female (odds ratio [OR] = 1.37; 95% confidence interval [CI]: 1.23 to 1.53), black (OR = 1.26 vs. whites; 95% CI: 1.02 to 1.56), and older (OR = 2.25 per 10-year increase; 95% CI: 2.05 to 2.43) than patients who underwent angiography. Angiography use was lower in blacks(OR = 0.78; 95% CI: 0.72 to 0.83) than in whites, and lower in women (OR = 0.83; 95% CI: 0.80 to 0.86) than in men. Increased refusal explained 6% (95% CI: -3% to 15%) of the difference in angiography use between whites and blacks, and 16% (95% CI: 10% to 22%) of the difference between men and women. After adjustment for patient characteristics, refusal of angiography was not associated with worse survival at I year (OR = 0.99; 95% CI: 0.82 to 1.20). CONCLUSION: Among Medicare beneficiaries, elderly female and black patients are more likely to refuse angiography than are male and white patients. However, patient refusal is uncommon and accounts for only a small fraction of the racial and sex differences in use of angiography after myocardial infarction. Am J Med. (C) 2002 by Excerpta Medica, Inc.