Association of Race and Ethnicity on the Management of Acute Non-ST-Segment Elevation Myocardial Infarction.
Association of Race and Ethnicity on the Management of Acute Non-ST-Segment Elevation Myocardial Infarction.
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急性非ST段抬高心肌梗死治疗中种族和民族的相关性。
DOI：
10.1161/jaha.121.025758
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发表时间：
2022-06-21
影响因子：
5.4
通讯作者：
Magnani, Jared W.
中科院分区：
文献类型：
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作者：
Tertulien, Tarryn;Broughton, Stephen T.;Swabe, Gretchen;Essien, Utibe R.;Magnani, Jared W.
先前的研究报告了急性心肌梗死 (MI) 治疗方面的种族差异，许多研究的协变量有限或现已过时。我们在一大群具有不同社会背景的受保患者中研究了 MI 治疗中的种族和民族差异，特别是非 ST 段抬高型 MI (NSTEMI)。我们假设在当代数据中，接受冠状动脉造影或经皮冠状动脉介入治疗方面的种族和民族差异将持续存在。我们确定了健康声明数据库记录的 2017 年至 2019 年出现 I 型 NSTEMI 事件的个人。数据库将种族和民族分类为亚洲人、黑人、西班牙裔或白人。协变量包括人口统计数据（年龄、性别、种族和民族）； Elixhauser 变量，包括心血管危险因素和其他合并症；估计家庭年收入和教育程度的社会因素。我们按种族、民族和收入类别以及多变量调整模型检查了冠状动脉造影和经皮冠状动脉介入治疗的比率。我们确定了 2017 年至 2019 年间发生 NSTEMI 事件的 87094 名个体（年龄 73.8±11.6 岁；55.6% 男性；2.6% 亚洲人，13.4% 黑人，11.2% 西班牙裔，72.7% 白人）。黑人种族个体接受冠状动脉造影的可能性较小（比值比 [OR]， 0.93；[95% CI，0.89–0.98]）和经皮冠状动脉介入治疗（OR，0.86；[95% CI，0.81–0.90]）高于白人。与白人相比，西班牙裔人接受冠状动脉造影和经皮冠状动脉介入治疗（OR，0.85；[95% CI，0.81-0.89]）的可能性较小（OR，0.88；[95% CI，0.84-0.93]）。较高的家庭年收入减弱了所有种族和族裔群体接受冠状动脉造影的差异。我们发现，对 NSTEMI 患者的管理存在显着的种族和民族差异，但家庭收入的增加略微减弱了这种差异。我们的研究结果表明当代 NSTEMI 治疗中健康不平等的持续证据。
Prior studies have reported disparities by race in the management of acute myocardial infarction (MI), with many studies having limited covariates or now dated. We examined racial and ethnic differences in the management of MI, specifically non–ST‐segment‐elevation MI (NSTEMI), in a large, socially diverse cohort of insured patients. We hypothesized that the racial and ethnic disparities in the receipt of coronary angiography or percutaneous coronary intervention would persist in contemporary data. We identified individuals presenting with incident, type I NSTEMI from 2017 to 2019 captured by a health claims database. Race and ethnicity were categorized by the database as Asian, Black, Hispanic, or White. Covariates included demographics (age, sex, race, and ethnicity); Elixhauser variables, including cardiovascular risk factors and other comorbid conditions; and social factors of estimated annual household income and educational attainment. We examined rates of coronary angiography and percutaneous coronary intervention by race and ethnicity and income categories and in multivariable‐adjusted models. We identified 87 094 individuals (age 73.8±11.6 years; 55.6% male; 2.6% Asian, 13.4% Black, 11.2% Hispanic, 72.7% White) with incident NSTEMI events from 2017 to 2019. Individuals of Black race were less likely to undergo coronary angiography (odds ratio [OR], 0.93; [95% CI, 0.89–0.98]) and percutaneous coronary intervention (OR, 0.86; [95% CI, 0.81–0.90]) than those of White race. Hispanic individuals were less likely (OR, 0.88; [95% CI, 0.84–0.93]) to undergo coronary angiography and percutaneous coronary intervention (OR, 0.85; [95% CI, 0.81–0.89]) than those of White race. Higher annual household income attenuated differences in the receipt of coronary angiography across all racial and ethnic groups. We identified significant racial and ethnic differences in the management of individuals presenting with NSTEMI that were marginally attenuated by higher household income. Our findings suggest continued evidence of health inequities in contemporary NSTEMI treatment.