Racial and Ethnic Disparities in Incidence and Prognosis of Perioperative Stroke Among Pediatric Cardiac Transplant Recipients.
Racial and Ethnic Disparities in Incidence and Prognosis of Perioperative Stroke Among Pediatric Cardiac Transplant Recipients.
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DOI：
10.1161/jaha.121.025149
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发表时间：
2022-07-19
影响因子：
5.4
通讯作者：
Mittleman, Murray A.
中科院分区：
文献类型：
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作者：
Lehman, Laura L.;Mostofsky, Elizabeth;Salia, Soziema;Gupta, Suruchi;Barrera, Francisco J.;Liou, Lathan;Mittleman, Murray A.
在一般人群中，黑人儿童的中风发病率和中风后全因死亡率高于白色儿童。从心脏移植后6个月开始，黑人儿童的死亡率高于白色儿童。然而，儿童心脏移植受者围手术期卒中的发生率和全因死亡率是否存在种族和民族差异尚不清楚。使用移植受体科学登记处，我们研究了1994年1月至2019年9月期间在美国接受首次心脏移植的儿童。使用多变量逻辑回归，我们评估了种族和民族与围手术期卒中之间的关系。我们采用多变量分段考克斯回归分析来研究围手术期卒中幸存者的种族和民族与死亡率之间的关系。在8224例接受首次心脏移植的儿童中，255例（3%）发生围手术期卒中。与白色儿童相比，黑人儿童围手术期卒中的几率低32%（调整后的比值比，0.68 [95%CI，0.46-0.996]）。围手术期卒中后，黑人和白色儿童在前6个月的死亡率相似（校正风险比[HR]，0.99 [95% CI，0.44-2.26]）。然而，6个月后，黑人儿童的死亡率高于白色儿童（校正的HR，3.36 [95% CI，1.22-9.22]）。在儿童心脏移植受者中，黑人儿童围手术期卒中的发生率低于白色儿童。在围手术期卒中的幸存者中，不同人种和种族的死亡率最初相似，但超过6个月后，黑人儿童的死亡率比白色儿童高3倍以上。确定和干预护理方面的潜在差异对于解决这些差异至关重要。
In the general population, Black children have a higher incidence of stroke and all‐cause mortality after stroke than White children. Beginning 6 months following cardiac transplantation, Black children have higher mortality than White children. However, whether there are racial and ethnic disparities in incidence and all‐cause mortality following perioperative stroke among pediatric cardiac transplant recipients is unknown. Using the Scientific Registry of Transplant Recipients, we studied children who underwent their first heart transplant in the United States between January 1994 and September 2019. Using multivariable logistic regression, we assessed the association between race and ethnicity and perioperative stroke. We used multivariable piecewise Cox regression to examine the association between race and ethnicity and mortality among survivors of perioperative stroke. Among 8224 children who had a first cardiac transplant, 255 (3%) had a perioperative stroke. Black children had 32% lower odds of perioperative stroke compared with White children (adjusted odds ratio, 0.68 [95% CI, 0.46–0.996]). Following perioperative stroke, mortality rates were similar for Black and White children in the first 6 months (adjusted hazard ratio [HR], 0.99 [95% CI, 0.44–2.26]). However, Black children had a higher mortality rate than White children beyond 6 months (adjusted HR, 3.36 [95% CI, 1.22–9.22]). Among pediatric cardiac transplant recipients, Black children have a lower incidence of perioperative stroke than White children. Among survivors of perioperative stroke, mortality is initially similar by race and ethnicity, but beyond 6 months, Black children have over a 3‐fold higher mortality rate than White children. Identifying and intervening on potential differences in care is essential to addressing these disparities.