Trends in implantable cardioverter-defibrillator racial disparity - The importance of geography
Trends in implantable cardioverter-defibrillator racial disparity - The importance of geography
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DOI：
10.1016/j.jacc.2004.07.061
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发表时间：
2005-01-04
影响因子：
24
通讯作者：
Garber, AM
中科院分区：
文献类型：
--
作者：
Groeneveld, PW;Heidenreich, PA;Garber, AM
本研究旨在确定植入式心律转复除颤器（ICD）使用的种族差异是否随着时间的推移而改善，以及ICD使用的小区域地理差异是否导致了全国范围内的种族差异。背景虽然心脏手术中的种族差异已被充分记录，但尚不清楚是否随着时间的推移而有所改善。低ICD的使用率，主要是黑色的地理区域可能加剧了国家水平的disparity.METHODS出院摘要老年黑人和白色医疗保险受益人住院治疗室性心律失常，从1990年至2000年进行了分析，以确定ICD植入发生在90天内的首次住院治疗。构建多变量逻辑回归模型，以评估ICD植入、入院年份和每个患者所在县的黑人居民比例之间的关系，同时控制临床、医院和人口统计学特征。在1990年至1992年期间，与白人相比，黑人患者接受ICD的优势比为0.52（95%置信区间[CI] 0.42至0.64）。然而，到1999年至2000年，黑人的比值比上升至0.69（95% CI 0.61至0.78）（趋势检验p = 0.01）。大约20%的这一趋势可以解释为减少在ICD使用的地区与较大的黑色和主要是白色population.CONCLUSIONS率之间的地理变化ICD植入变得更加平等的白人和黑人在20世纪90年代，虽然持续的差距仍然在十年的结束。心血管手术率的地理均衡可能是纠正卫生保健差距的一个重要机制。(C)2005年美国心脏病学会基金会
OBJECTIVES The study was designed to determine whether racial disparity in utilization of the implantable cardioverter-defibrillator (ICD) has improved over time, and whether small-area geographic variation in ICD utilization contributed to national levels of racial disparity.BACKGROUND Although racial disparities in cardiac procedures have been well-documented, it is unknown whether there has been improvement over time. Low ICD utilization rates in predominantly black geographic areas may have exacerbated national levels of disparity.METHODS Discharge abstracts from elderly black and white Medicare beneficiaries hospitalized with ventricular arrhythmias from 1990 to 2000 were analyzed to determine if ICD implantation occurred within 90 days of initial hospitalization. Multivariate logistic regression models were constructed to assess the relationship between ICD implantation, year of admission, and the percentage of black inhabitants in each patient's county of hospitalization while controlling for clinical, hospital, and demographic characteristics.RESULTS There was improvement in ICD implantation racial disparity: In the period 1990 to 1992, black patients had an odds ratio of 0.52 (95% confidence interval [CI] 0.42 to 0.64) for receiving an ICD compared with whites. However, by 1999 to 2000, the odds ratio for blacks had risen to 0.69 (95% CI 0.61 to 0.78) (test-for-trend p = 0.01). Approximately 20% of this trend could be explained by reduction in geographic variation in ICD use between areas with larger black and predominantly white populations.CONCLUSIONS Rates of ICD implants became more equal among whites and blacks during the 1990s, although persistent disparity remained at the decade's end. Geographic equalization in cardiovascular procedure rates may be an essential mechanism in rectifying disparities in health care. (C) 2005 by the American College of Cardiology Foundation