Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis
Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis
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DOI：
10.1016/j.jtcvs.2018.12.002
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发表时间：
2019-06-01
影响因子：
6
通讯作者：
Gaudino, Mario
中科院分区：
文献类型：
--
作者：
Benedetto, Umberto;Kamel, Mohamed K.;Gaudino, Mario
背景：尽管有一些报道，关于种族对冠状动脉旁路移植术（CABG）相关死亡率的影响，仍然存在相互矛盾的数据。我们的目的是通过进行风险调整后的荟萃分析，进一步了解种族对冠状动脉搭桥后死亡率的影响。方法：在PubMed、Embase、BioMed Central和Cochrane Central登记处检索相关研究。采用两两荟萃分析，以白人患者为参照，估计黑人、西班牙裔和亚洲患者的医院死亡相对风险。采用随机效应模型的通用反方差法获得风险调整后的meta分析估计。结果：共选择28项研究进行分析。共有21项研究报告了黑人（n = 222,892）与白人（n = 3,884,043）患者的住院死亡率，7项研究报告了西班牙裔（n = 91,256）与白人（n = 1,458,524）， 9项研究报告了亚洲人（n = 27,820）与白人（n = 1,081,642）。与白人患者相比，黑人患者的医院死亡校正风险显著高于白人患者（校正优势比[OR]， 1.25； 95%可信区间[CI]， 1.13-1.39; P < .001），而亚洲患者（校正优势比[OR]， 1.33; 95% CI, 0.99-1.77; P = 0.05）和西班牙裔患者（校正优势比[OR]， 1.08; 95% CI, 0.94-1.23; P = .26）的医院死亡校正风险无统计学差异。meta回归显示，在最近的一系列研究中，黑人（P = 0.02）、白人（P = 0.0007）和亚洲人（P = 0.01）的死亡率都有显著下降趋势，但西班牙裔（P = 0.41）没有这种趋势。然而，由于不同种族的死亡率较低，研究组之间的相对劣势仍然存在，这可能解释了研究期间和种族对黑人（校正P = 0.09）、亚洲（校正P = 0.63）和西班牙裔（校正P = 0.97）患者死亡率影响之间缺乏相互作用的原因。结论：本荟萃分析显示，尽管在降低主要种族/族裔群体的住院死亡率方面取得了进展，但CABG术后住院死亡率的种族差异仍然存在。
Background: Despite several reports, there are still conflicting data on the influence of ethnicity on mortality rates associated with coronary artery bypass grafting (CABG). We aimed to get further insights into the effect of race on mortality following CABG by performing a risk adjusted meta-analysis.Methods: Relevant studies were searched on PubMed, Embase, BioMed Central, and the Cochrane Central register. Pairwise meta-analysis was used to estimate the relative risk of hospital death of black, Hispanic, and Asian patients using white patients as reference. Risk adjusted meta-analytic estimates were obtained using generic inverse variance methods with random effect model.Results: A total of 28 studies were selected for analysis. A total of 21 studies reported on hospital mortality in black (n = 222,892) versus white (n = 3,884,043) patients, 7 studies reported on Hispanic (n = 91,256) versus white (n = 1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n = 1,081,642). When compared with white patients, adjusted risk of hospital death was significantly greater for black patients (adjusted odds ratio [OR], 1.25; 95 % confidence interval [CI], 1.13-1.39; P < .001), and not statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P = .05) and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P = .26). Meta-regression showed a significant trend toward lower mortality rates in most recent series in both black (P = .02) and white (P = .0007) and Asian (P = .01) but not for Hispanic (P = .41). However, as mortality rates were lower across the different races, the relative disadvantage between the study groups persisted, which may explain the lack of interaction between study period and race effect on mortality for black (adjusted P = .09), Asian (adjusted P = .63), and Hispanic (adjusted P = .97) patients.Conclusions: The present meta-analysis showed that despite progress is being made in lowering in-hospital mortality rates among the major racial/ethnic groups, ethnical disparities in hospital mortality after CABG remain.