Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery.
Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery.
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DOI：
10.1001/jamanetworkopen.2022.47968
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发表时间：
2022-12-01
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.;Maddox, Karen E. Joynt;Mazzefi, Michael;Knight, Peter W.;Eaton, Michael P.;Feng, Changyong;Kertai, Miklos D.;Albernathy, James;Wu, Isaac Y.;Wyrobek, Julie A.;Cevasco, Marisa;Desai, Nimesh;Dick, Andrew W.
非西班牙裔黑人和西班牙裔个人在接受微创二尖瓣手术方面是否存在差异？在这项对103名 753名患者的横断面研究中，非西班牙裔黑人个体接受微创二尖瓣手术的可能性较小，而西班牙裔个体与非西班牙裔白人个体进行微创手术的比率相似。非西班牙裔黑人比非西班牙裔白人更有可能拥有医疗补助保险，并接受数量较少的外科医生的治疗，这两个因素都与较低的微创手术率有关。这些发现表明，改善心血管药物公平性的努力可能需要包括扩大获得商业保险和大量外科医生的机会。这项横断面研究考察了使用微创二尖瓣手术时的种族和民族差异。来自种族和少数民族群体的人在接受微创二尖瓣手术(MIMVS)方面是否存在差异尚不清楚。调查在使用MIMVS方面的种族和民族差异。这项横断面研究使用了胸科外科学会数据库中2014至2019年间接受二尖瓣手术的患者的数据。统计分析时间为2022年1月24日至8月11日。患者被归类为非西班牙裔白人、非西班牙裔黑人和西班牙裔个体。用Logistic回归分析MIMVS(与全胸骨切开相比)与种族和民族的关系。在103例 753例二尖瓣手术患者中(平均年龄62[13]岁；47例 886女性(46.2%))，10例(10.0%)为非西班牙裔黑人，89例(85.8%)为非西班牙裔白人，4,336例(4.2%)为西班牙裔。与非西班牙裔白人相比，非西班牙裔黑人更有可能拥有医疗补助保险(优势比[OR]，2.21；95%CI，1.64-2.98；P <； .001)，并更有可能接受低容量外科医生的护理(OR，4.45；95%CI，4.01-4.93；P <； .001)。与非西班牙裔白人相比，非西班牙裔黑人患MIMVS的可能性较小(OR，0.65；95%CI，0.58-0.73；P <； .001)，而西班牙裔黑人患MIMVS的可能性并不比非西班牙裔白人低(OR，1.08；95%CI，0.67-1.75；P = .74)。商业保险患者接受MIMVS的几率是医疗补助保险患者的2.35倍(OR，2.35；95%CI，2.06-2.68；P <； .001)。与小容量外科医生(少于20例)相比，由超大容量外科医生(300例或更多)手术的患者接受MIMVS的几率(OR，20.70；95%CI，12.7-33.9；P <； .001)高20.7倍。在调整了患者风险后，与非西班牙裔白人相比，非西班牙裔黑人个体仍然不太可能发生MIMVS(调整后的OR[AOR]，0.88；95%CI，0.78-0.99；P = .04)，更有可能死亡或经历重大并发症(AOR，1.25；95%CI，1.16-1.35；P <； .001)。在这项横断面研究中，与非西班牙裔白人患者相比，非西班牙裔黑人患者接受MIMVS的可能性较小，死亡或经历重大并发症的可能性更大。这些发现表明，减少心血管医学不平等的努力可能需要包括增加获得私人保险和大量外科医生的机会。
Do non-Hispanic Black and Hispanic individuals experience disparities in access to minimally invasive mitral valve surgery? In this cross-sectional study of 103 753 patients, non-Hispanic Black individuals were less likely to undergo minimally invasive mitral valve surgery, whereas Hispanic individuals had similar rates of minimally invasive surgery compared with non-Hispanic White individuals. Non-Hispanic Black individuals were more likely than non-Hispanic White individuals to have Medicaid insurance and to be treated by low-volume surgeons, both factors being associated with lower rates of minimally invasive surgery. These findings suggest that efforts to improve equity in cardiovascular medicine may need to include expanding access to commercial insurance and high-volume surgeons. This cross-sectional study examines racial and ethnic disparities in the utilization of minimally invasive mitral valve surgery. Whether people from racial and ethnic minority groups experience disparities in access to minimally invasive mitral valve surgery (MIMVS) is not known. To investigate racial and ethnic disparities in the utilization of MIMVS. This cross-sectional study used data from the Society of Thoracic Surgeons Database for patients who underwent mitral valve surgery between 2014 and 2019. Statistical analysis was performed from January 24 to August 11, 2022. Patients were categorized as non-Hispanic White, non-Hispanic Black, and Hispanic individuals. The association between MIMVS (vs full sternotomy) and race and ethnicity were evaluated using logistic regression. Among the 103 753 patients undergoing mitral valve surgery (mean [SD] age, 62 [13] years; 47 886 female individuals [46.2%]), 10 404 (10.0%) were non-Hispanic Black individuals, 89 013 (85.8%) were non-Hispanic White individuals, and 4336 (4.2%) were Hispanic individuals. Non-Hispanic Black individuals were more likely to have Medicaid insurance (odds ratio [OR], 2.21; 95% CI, 1.64-2.98; P < .001) and to receive care from a low-volume surgeon (OR, 4.45; 95% CI, 4.01-4.93; P < .001) compared with non-Hispanic White individuals. Non-Hispanic Black individuals were less likely to undergo MIMVS (OR, 0.65; 95% CI, 0.58-0.73; P < .001), whereas Hispanic individuals were not less likely to undergo MIMVS compared with non-Hispanic White individuals (OR, 1.08; 95% CI, 0.67-1.75; P = .74). Patients with commercial insurance had 2.35-fold higher odds of undergoing MIMVS (OR, 2.35; 95% CI, 2.06-2.68; P < .001) than those with Medicaid insurance. Patients operated by very-high volume surgeons (300 or more cases) had 20.7-fold higher odds (OR, 20.70; 95% CI, 12.7-33.9; P < .001) of undergoing MIMVS compared with patients treated by low-volume surgeons (less than 20 cases). After adjusting for patient risk, non-Hispanic Black individuals were still less likely to undergo MIMVS (adjusted OR [aOR], 0.88; 95% CI, 0.78-0.99; P = .04) and were more likely to die or experience a major complication (aOR, 1.25; 95% CI, 1.16-1.35; P < .001) compared with non-Hispanic White individuals. In this cross-sectional study, non-Hispanic Black patients were less likely to undergo MIMVS and more likely to die or experience a major complication than non-Hispanic White patients. These findings suggest that efforts to reduce inequity in cardiovascular medicine may need to include increasing access to private insurance and high-volume surgeons.
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