Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke.
Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke.
复制标题
急性中风患者中风后并发症医疗管理中的种族和民族差异。
DOI：
10.1161/jaha.123.030537
复制
发表时间：
2024
影响因子：
5.4
通讯作者：
Ifejika,NnekaL
中科院分区：
文献类型：
--
作者：
Simmonds,KentP;Atem,FolefacD;Welch,BabuG;Ifejika,NnekaL
BackgroundTo通知临床实践中，我们试图确定常见的poststroke complications.Methods和ResultsA急性住院，首次非西班牙裔白色（NHW），非西班牙裔黑人和西班牙裔中风患者队列的种族和民族差异，从电子病历的51个大型医疗保健组织（2003年1月1日至2022年12月5日）。使用匹配的倾向评分来解释基线差异。主要结局包括接受与以下卒中后并发症管理相关的药物治疗：觉醒/疲劳、痉挛状态、情绪、睡眠、神经源性膀胱、神经源性肠和癫痫发作。在14天、90天和365天测量差异。亚组分析包括仅限于缺血性卒中患者的差异，年龄较小（<65岁），并按十年（2003-2012年和2013-2022年）分层。匹配前，最终队列包括348286例首次卒中患者。匹配结果为63722个非西班牙裔黑人-NHW对和24009个西班牙裔-NHW对。非西班牙裔黑人（与NHW相比）患者接受所有卒中后并发症治疗的可能性显著降低，第14天时差异最大的是觉醒/疲劳（相对风险（RR），0. 58 [95% CI，0. 54 - 0. 62]）、痉挛状态（RR，0. 64 [95% CI，0.0.62-0.67]）和情绪障碍（RR，0. 72 [95% CI，0. 70 - 0. 74]）。西班牙裔-NHW差异相似，尽管幅度较小，但痉挛（RR，0.67 [95% CI，0.63-0.72]）、觉醒/疲劳（RR，0.77 [95% CI，0.70-0.85]）和情绪障碍（RR，0.79 [95% CI，0.77-0.82]）存在最大差异。亚组分析显示缺血性卒中和年龄<65岁患者的模式相似。本十年的差异仍然显着，但与前decade.ConclusionsThere是显着的种族和民族的差异在治疗中风后并发症的幅度较小。差异在14天时最大，概述了早期识别和管理的重要性。
BackgroundTo inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications.Methods and ResultsA cohort of acutely hospitalized, first‐time non‐Hispanic White (NHW), non‐Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003–2012 and 2013–2022). Before matching, the final cohort consisted of 348 286 patients with first‐time stroke. Matching resulted in 63 722 non‐Hispanic Black–NHW pairs and 24 009 Hispanic–NHW pairs. Non‐Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54–0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62–0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70–0.74]) at 14 days. Hispanic–NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63–0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70–0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77–0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade.ConclusionsThere are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.