Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation.
Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation.
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DOI：
10.1016/j.hrthm.2015.03.031
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发表时间：
2015-07
期刊：
影响因子：
5.5
通讯作者：
Vaughan Sarrazin MS
中科院分区：
文献类型：
--
作者：
Bhave PD;Lu X;Girotra S;Kamel H;Vaughan Sarrazin MS
心房颤动(AF)与中风和死亡的风险增加有关。对于房颤，统一使用适当的治疗方法可能有助于降低这些风险。我们试图确定在医疗保险受益人中新诊断的房颤的治疗中是否存在显著的种族和性别差异。我们使用医疗保险受益人的行政遭遇数据来识别2010-2011年间新诊断的房颤患者。房颤初步诊断后接受的服务被编目，包括去看心脏病专家或电生理医生，导管消融程序，以及口服抗凝剂、心率控制剂和抗心律失常药物的使用。总体而言，517,941名患者符合研究标准，其中452,986名(87%)是白人，36,425名(7%)是黑人，28,530名(6%)是西班牙裔。男性患者占队列的209,788人(41%)。在多变量分析中，种族和性别对房颤相关服务的使用有统计学意义上的差异，白人患者和男性患者接受的护理最多。最显著的差异是导管消融(西班牙裔与白人：调整后的风险比[AHR]0.70；95%可信区间[CI]0.63-0.79；P<；.001；女性与男性：AHR 0.65；95%CI 0.63-0.68；P<；.001)和接受口服抗凝治疗(黑人与白人：AHR 0.94；95%CI 0.92-0.95；P<；.001；西班牙裔与白人：AHR 0.94；95%CI 0.93-0.97；P<；；.001；女性与男性：AHR 0.93；95%CI 0.93-0.94；P<；.001)。种族和性别似乎对为这群被诊断为房颤的医疗保险受益者提供的医疗保健有重大影响。可能的解释包括准入方面的种族差异、患者偏好、治疗偏见和未测量的临床特征。
Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010–2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiolo-gist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63–0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63–0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92–0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93–0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93–0.94; P < .001). Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.