Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999-2014.
Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999-2014.
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DOI：
10.1161/jaha.118.009014
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发表时间：
2018-07-12
影响因子：
5.4
通讯作者：
Krumholz HM
中科院分区：
文献类型：
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作者：
Angraal S;Khera R;Wang Y;Lu Y;Jean R;Dreyer RP;Geirsson A;Desai NR;Krumholz HM
经过十多年的定向努力，以减少冠状动脉旁路移植术（CABG）使用和CABG后结局的性别和种族差异，我们试图评估CABG的使用及其结局在不同性别和种族亚组中的演变。使用1999年至2014年在美国接受冠状动脉旁路移植术的所有按服务收费医疗保险受益人的数据，我们检查了性别和种族在冠状动脉旁路移植术使用和冠状动脉旁路移植术后结果（住院、30天和1年死亡率和30天再入院）的日历年趋势方面的差异。从1999年到2014年，共有1863719名医疗保险服务费受益人（33.6%女性，4.6%黑人）接受了CABG，每10万人年的CABG手术从611例减少到245例。男性与女性相比，白人与黑人相比，CABG的利用率更高，所有亚组均有所下降。CABG后死亡率的年下降率较高（95%置信区间）（住院，-2.70%[-2.97，-2.44]; 30天，-2.29%[-2.54，-2.04]; 1年死亡率，-1.67%[-1.88，-1.46]）和黑人（住院，-3.31%[-4.02，-2.60]; 30天，-2.80%[-3.49，-2.12]; 1年死亡率，-2.38%[-2.92，-1.84]），分别与男性和白人相比。妇女和黑人的死亡率仍然较高，但随着时间的推移，差异逐渐缩小。所有患者组的年度调整后30天再入院率保持不变。女性和黑人患者的冠状动脉旁路移植术死亡率分别持续高于男性和白色患者，尽管随着时间的推移下降幅度更大。这些调查结果表明取得了进展，但也表明需要进一步取得进展。
With over a decade of directed efforts to reduce sex and racial differences in coronary artery bypass grafting (CABG) utilization, and post‐CABG outcomes, we sought to evaluate how the use of CABG and its outcomes have evolved in different sex and racial subgroups. Using data on all fee‐for‐service Medicare beneficiaries undergoing CABG in the United States from 1999 to 2014, we examined differences by sex and race in calendar‐year trends for CABG utilization and post‐CABG outcomes (in‐hospital, 30‐day, and 1‐year mortality and 30‐day readmission). A total of 1 863 719 Medicare fee‐for‐service beneficiaries (33.6% women, 4.6% black) underwent CABG from 1999 to 2014, with a decrease from 611 to 245 CABG procedures per 100 000 person‐years. Men compared with women and whites compared with blacks had higher CABG utilization, with declines in all subgroups. Higher post‐CABG annual declines in mortality (95% confidence interval) were observed in women (in‐hospital, −2.70% [−2.97, −2.44]; 30‐day, −2.29% [−2.54, −2.04]; and 1‐year mortality, −1.67% [−1.88, −1.46]) and blacks (in‐hospital, −3.31% [−4.02, −2.60]; 30‐day, −2.80% [−3.49, −2.12]; and 1‐year mortality, −2.38% [−2.92, −1.84]), compared with men and whites, respectively. Mortality rates remained higher in women and blacks, but differences narrowed over time. Annual adjusted 30‐day readmission rates remained unchanged for all patient groups. Women and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. These findings indicate progress, but also the need for further progress.