Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long-Term Mortality
Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long-Term Mortality
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DOI：
10.1161/jaha.117.008088
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发表时间：
2018-04-17
影响因子：
5.4
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Li, Shanshan;Fonarow, Gregg C.;Bhatt, Deepak L.
背景-心脏康复（CR）转诊推荐给符合条件的患者，不分性别或种族。目前还不清楚是否不平等的CR转介的做法是与患者的长期survival.Methods和结果，我们联系了美国心脏协会获得与指南冠状动脉疾病登记与医疗保险索赔数据48993冠状动脉疾病患者从365家医院在2003年和2009年之间在美国。我们使用广义估计方程来估计CR转诊与医院内聚集性死亡率之间的相关性。在2003年至2009年期间，只有40%的合格患者接受了CR转诊。女性接受CR转诊的可能性比男性低12%。黑人、西班牙裔和亚裔患者接受CR转诊的可能性分别比白色患者低20%、36%和50%。CR转诊与降低40%的3年全因死亡率相关。出院时接受CR转诊的妇女和少数民族患者的死亡率显著低于未接受CR转诊的患者（女性的比值比为0.61 [95%置信区间，0.56-0.66]，黑人为0.75 [95%置信区间，0.63-0.88]，西班牙裔为0.62 [95%置信区间，0.50-0.79]，亚洲患者为0.63 [95%置信区间，0.46-0.85]）。百分之七的黑人与白色死亡率的差距可能会减少公平CR referreration. Conclusions CR转诊率在出院时仍然很低。妇女和少数民族在出院时接受CR转诊的差距很大，通过消除CR转诊方面的不平等，死亡率差距可能会缩小。
Background-Cardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients' long-term survival.Methods and Results-We linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3-year all-cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios 0.61 [95% confidence interval, 0.56-0.66] for women, 0.75 [95% confidence interval, 0.63-0.88] for black, 0.62 [95% confidence interval, 0.50-0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46-0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral.Conclusions-CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.