Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness.
Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness.
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DOI：
10.1097/ccm.0000000000002313
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发表时间：
2017-06
影响因子：
8.8
通讯作者：
Lederer DJ
中科院分区：
文献类型：
--
作者：
Baldwin MR;Sell JL;Heyden N;Javaid A;Berlin DA;Gonzalez WC;Bach PB;Maurer MS;Lovasi GS;Lederer DJ
确定少数族裔或种族是否与重症老年（年龄≥65岁）幸存者的死亡率相关，并受医疗保险覆盖情况的介导。
一项回顾性队列研究。
纽约市的两个学术医疗中心。
共有1947名连续的白人（1107名）、黑人（361名）和西班牙裔（479名）老年人，他们在2006年至2009年期间首次入住内科重症监护病房，并存活至出院。
无。
我们从电子健康记录中获取人口统计学、保险和临床数据，从2010年美国人口普查区数据中确定每位患者所在社区层面的社会经济数据，并使用社会保障死亡指数确定死亡日期。研究对象的平均（标准差）年龄为79（8.6）岁，中位（四分位间距）随访时间为1.6（0.4 - 3.0）年。与白人相比，黑人和西班牙裔的死亡率相似（调整后的风险比[HR]为0.92，95%置信区间为0.76 - 1.11；调整后的HR为0.92，95%置信区间为0.76 - 1.12）。与拥有商业保险和医疗保险的人相比，仅拥有医疗保险的人（调整后的HR为1.43，95%置信区间为1.03 - 1.98）和医疗补助的人（调整后的HR为1.30，95%置信区间为1.10 - 1.52）死亡率更高。作为最年长的重症监护病房幸存者（年龄>82岁）、机械通气幸存者以及出院后入住专业护理机构的医疗补助接受者死亡率最高（交互作用P值分别为0.08、0.03和0.17）。
老年人重症后的死亡率因保险覆盖范围而异，但与种族或族裔无关。仅拥有联邦或州保险覆盖的人比拥有额外商业保险的人死亡率更高。
To determine whether minority race or ethnicity are associated with mortality and mediated by health insurance coverage among older (age ≥65 years) survivors of critical illness. A retrospective cohort study. Two New York City academic medical centers. A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge. None. We obtained demographic, insurance, and clinical data from electronic health records, determined each patient’s neighborhood-level socioeconomic data from 2010 US Census tract data, and determined death dates using the Social Security Death Index. Subjects had a mean (SD) age of 79 (8.6) years and median (IQR) follow-up time of 1.6 (0.4–3.0) years. Blacks and Hispanics had similar mortality rates compared to whites (adjusted-hazard ratio [HR] 0.92, 95% CI 0.76–1.11 and adjusted-HR 0.92, 95% CI 0.76–1.12, respectively). Compared to those with commercial insurance and Medicare, higher mortality rates were observed for those with Medicare only (adjusted-HR 1.43, 95% CI 1.03–1.98) and Medicaid (adjusted-HR 1.30, 95% CI 1.10–1.52). Medicaid recipients who were the oldest ICU survivors (age >82 years), survivors of mechanical ventilation, and discharged to skilled-care facilities had the highest mortality rates (p-for-interaction 0.08, 0.03, and 0.17, respectively). Mortality after critical illness among older adults varies by insurance coverage, but not by race or ethnicity. Those with federal or state insurance coverage only had higher mortality rates than those with additional commercial insurance.