Was COVID-19 Associated With Worsening Inequities in Stroke Treatment and Outcomes?
Was COVID-19 Associated With Worsening Inequities in Stroke Treatment and Outcomes?
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DOI：
10.1161/jaha.123.031221
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发表时间：
2023-10-03
影响因子：
5.4
通讯作者：
Dick, Andrew W.
中科院分区：
文献类型：
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作者：
Glance, Laurent G.;Benesch, Curtis G.;Maddox, Karen E. Joynt;Bender, Matthew T.;Shang, Jingjing;Stone, Patricia W.;Lustik, Stewart J.;Nadler, Jacob W.;Galton, Christopher;Dick, Andrew W.
COVID-19 给医院带来了压力，可能对黑人和西班牙裔患者的中风结果和治疗产生了不成比例的影响。这项回顾性研究使用了 2016 年至 2020 年期间 100% 医疗保险提供者分析和审查文件数据。我们使用中断时间序列分析来检查 COVID-19 大流行是否加剧了中风结果和再灌注治疗的差异。在 1 142 560 例因急性缺血性中风住院的患者中，90 912 例 (8.0%) 是西班牙裔； 162 752 (14.2%) 是非西班牙裔黑人； 888 896 (77.8%) 是非西班牙裔白人。调整后的死亡率增加了 51%（调整后的比值比 [aOR]，1.51 [95% CI，1.34–1.69]；P<0.001），而住院患者的非回家出院率下降了 11%（aOR，0.89 [95% CI，0.82–0.96]；P=0.003）。 COVID-19 患者>30%。随着每周 COVID-19 负担的增加，运动缺陷的总体发生率（P=0.25）没有增加，再灌注治疗的发生率也没有降低。与白人相比，黑人患者的 30 天死亡率较低（aOR，0.70 [95% CI，0.69–0.72]；P<0.001），但运动缺陷发生率较高（aOR，1.14 [95% CI，1.12–1.16]；P<0.001）。与白人相比，西班牙裔患者的 30 天死亡率较低，运动缺陷发生率相似。与白人相比，随着每周 COVID-19 负担的增加，黑人和西班牙裔的不良后果或再灌注治疗的减少没有差异。这项针对医疗保险患者的全国性研究发现，没有证据表明医院的 COVID-19 负担加剧了因急性缺血性中风入院的黑人和西班牙裔患者的治疗和结果差异。
COVID‐19 stressed hospitals and may have disproportionately affected the stroke outcomes and treatment of Black and Hispanic individuals. This retrospective study used 100% Medicare Provider Analysis and Review file data from between 2016 and 2020. We used interrupted time series analyses to examine whether the COVID‐19 pandemic exacerbated disparities in stroke outcomes and reperfusion therapy. Among 1 142 560 hospitalizations for acute ischemic strokes, 90 912 (8.0%) were Hispanic individuals; 162 752 (14.2%) were non‐Hispanic Black individuals; and 888 896 (77.8%) were non‐Hispanic White individuals. The adjusted odds of mortality increased by 51% (adjusted odds ratio [aOR], 1.51 [95% CI, 1.34–1.69]; P<0.001), whereas the rates of nonhome discharges decreased by 11% (aOR, 0.89 [95% CI, 0.82–0.96]; P=0.003) for patients hospitalized during weeks when the hospital's proportion of patients with COVID‐19 was >30%. The overall rates of motor deficits (P=0.25) did not increase, and the rates of reperfusion therapy did not decrease as the weekly COVID‐19 burden increased. Black patients had lower 30‐day mortality (aOR, 0.70 [95% CI, 0.69–0.72]; P<0.001) but higher rates of motor deficits (aOR, 1.14 [95% CI, 1.12–1.16]; P<0.001) than White individuals. Hispanic patients had lower 30‐day mortality and similar rates of motor deficits compared with White individuals. There was no differential increase in adverse outcomes or reduction in reperfusion therapy among Black and Hispanic individuals compared with White individuals as the weekly COVID‐19 burden increased. This national study of Medicare patients found no evidence that the hospital COVID‐19 burden exacerbated disparities in treatment and outcomes for Black and Hispanic individuals admitted with an acute ischemic stroke.