Racial disparity in access to cardiac intensive care over 20 years.
Racial disparity in access to cardiac intensive care over 20 years.
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DOI：
10.1080/13557858.2010.544292
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发表时间：
2011-04
影响因子：
3.1
通讯作者：
Thorpe RJ
中科院分区：
文献类型：
--
作者：
Shippee TP;Ferraro KF;Thorpe RJ
本文的目的是：(1) 系统地研究在急症护理医院获得和使用心脏监护病房 (CCU) 方面的种族差异； (2) 评估 CCU 住院后出院后死亡率的种族差异。对来自全国健康和营养检查调查 I：基线时 25 岁及以上成年人的流行病学随访研究的数据进行分析，以跟踪 CCU 使用情况和住院 20 多年后的生存情况 (N=4227)。估计值源自具有时间相关协变量的 Cox 比例风险模型以及负二项式和 tobit 回归分析。所有分析均根据疾病严重程度、住院史和资源进行调整。即使在调整了发病率、健康行为、既往住院经历和社会经济地位后，黑人成人入住 CCU 的可能性也低于白人成人。与入住 CCU 的黑人和白人成年人相比，黑人成年人在 CCU 的住院天数和住院时间比例都较小。黑人成年人在 20 年期间住院 CCU 的次数也较少，出院后死亡的可能性也更大，尽管后者的结果是由疾病严重程度介导的。更高的发病率、更低的入院率、更少的住院时间和更短的住院时间表明，种族不平等影响深远，甚至在 CCU 这样高度专业化的单位中也存在。黑人出院后死亡率较高是由疾病严重程度介导的事实表明，即使在高危人群中，发病因素（除了心脏问题）的积累也是一个突出的问题。总体研究结果表明，黑人成年人的劣势积累不仅限于酌情医疗措施，还存在于严重健康问题的重症监护中。
The purposes of this article are: (1) to systematically examine racial disparities in access to and use of cardiac care units (CCUs) in acute-care hospitals; and (2) to assess racial differences in post-hospital mortality following CCU stays. Data from the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study of adults aged 25 and older at baseline are analyzed to track CCU use and survival after hospitalization over 20 years (N=4227). Estimates are derived from Cox proportional-hazards models with time-dependent covariates and from negative binomial and tobit regression analyses. All analyses adjust for disease severity, hospitalization history, and resources. Black adults were less likely than White adults to be admitted to a CCU, even after adjusting for morbidities, health behaviors, previous hospitalization experience, and socioeconomic status. Comparing Black and White adults admitted to CCUs, Black adults spent fewer days and a smaller proportion of their hospital stay in CCUs. Black adults also had fewer CCU stays over the 20-year period and were more likely to die post-discharge, although the latter result was mediated by disease severity. Higher morbidity, lower admission rates, fewer stays, and shorter stays reveal that racial inequality is far-reaching and exists even in such highly-specialized units as CCUs. The fact that Black individuals’ greater post-discharge mortality was mediated by disease severity illustrated that even among high-risk individuals, the accumulation of morbidity factors (beyond cardiac problems) is a salient concern. Overall findings demonstrate that the accumulation of disadvantage for Black adults is not confined to discretionary medical measures, but also exists in critical care for serious health problems.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
影响因子：
5
作者：
Ferraro, Kenneth F.;Shippee, Tetyana Pylypiv
通讯作者：
Shippee, Tetyana Pylypiv
DOI：
10.1093/geronb/61.6.s299
发表时间：
2006-11-01
影响因子：
6.2
作者：
Ferraro, Kenneth F.;Thorpe, Roland J., Jr.;Jiang, Zhen
通讯作者：
Jiang, Zhen
影响因子：
8.3
作者：
Goldstein, LB;Samsa, GP;Horner, RD
通讯作者：
Horner, RD
影响因子：
158.5
作者：
Bach, PB;Cramer, LD;Begg, CB
通讯作者：
Begg, CB