Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction
Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction
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DOI：
10.1007/bf02598987
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发表时间：
1996-12-01
影响因子：
5.7
通讯作者：
Farmer, RM
中科院分区：
文献类型：
--
作者：
Allison, JJ;Kiefe, CI;Farmer, RM
目的：比较阿拉巴马州非裔美国人和白人老年医疗保险住院急性心肌梗死（AMI）患者的药物使用情况。设计：回顾性病历回顾。地点：阿拉巴马州所有急症护理医院。患者：1992年6月至1993年2月期间所有主要出院诊断为急性心肌梗死的医疗保险患者。我们排除了年龄小于65岁的患者以及非裔美国人或高加索人种的患者（N = 4052）。测量：我们首先对所有病例进行了粗略分析，按种族比较AMI患者使用溶栓、p-肾上腺素能阻滞剂和阿司匹林的情况。此外，我们开发了一个多变量模型，以接受治疗为结果，以人口统计学、疾病严重程度、合并症和算法确定的治疗候选性为协变量。这些算法是合作心血管项目的一部分，旨在为每种疗法确定一个“理想”的候选人群。主要结果：在所有病例中，9.2%（95%可信区间[CI] 6.8, 12.1）的非裔美国人接受了溶栓治疗，而白人接受溶栓治疗的比例为17.3%（95%可信区间[CI] 16.0, 18.6）。大约16.4%的患者接受了p-肾上腺素能阻断，45.1%的患者接受了阿司匹林，两者没有种族差异。通过多变量分析，非裔美国人接受溶栓治疗的校正优势比为0.55 （95% CI 0.41, 0.76）。β -肾上腺素能阻断剂的比值比为1.25 (95% CI 0.99, 1.59)，阿司匹林的比值比为1.13 （95% CI 0.96, 1.37）。非裔美国人出现胸痛较晚，但拒绝溶栓治疗的比例没有差异。结论：根据这项分析，阿拉巴马州的医生在非裔美国人和白种人中同等地使用β -肾上腺素能阻滞剂和阿司匹林。根据粗略分析，非裔美国人接受溶栓治疗的次数较少。多变量分析表明，即使在调整了包括临床算法适应症在内的几个协变量后，溶栓药物的使用也减少了。然而，少数非裔美国患者被认为是理想的溶栓候选者，降低了这一发现的准确性。
OBJECTIVE: To compare the use of medications in African-American and Caucasian elderly Medicare patients hospitalized with acute myocardial infarction (AMI) in Alabama.DESIGN: Retrospective medical record review.SETTING: All acute care hospitals in Alabama.PATIENTS: All Medicare patients with a principal discharge diagnosis of AMI from June 1992 through February 1993. We excluded those patients less than 65 years of age and those of ethnicity other than African-American or Caucasian (N = 4,052).MEASUREMENTS: We first performed a crude analysis using all cases to compare by race the use of thrombolysis, p-adrenergic blockade, and aspirin in the setting of AMI. In addition, we developed a multivariable model with receipt of therapy as the outcome and demographics, severity of illness, comorbidity, and algorithm-determined candidacy for therapy as covariates. The algorithms, developed as part of the Cooperative Cardiovascular Project, were designed to identify an ''ideal'' pool of candidates for each therapy.MAIN RESULTS: For all cases, 9.2% (95% confidence interval [CI] 6.8, 12.1) of African Americans received thrombolysis compared with 17.3% (95% CI 16.0, 18.6) of Caucasians. Approximately 16.4% of patients received p-adrenergic blockade, and 45.1% received aspirin, both with no racial difference. By multivariate analysis, the adjusted odds ratio for African Americans receiving thrombolysis was 0.55 (95% CI 0.41, 0.76). The corresponding odds ratio was 1.25 (95% CI 0.99, 1.59) for beta-adrenergic blockade and 1.13 (95% CI 0.96, 1.37) for aspirin. African Americans presented later after the onset of chest pain, but the refusal rate of thrombolytic therapy did not differ.CONCLUSIONS: According to this analysis, Alabama physicians used beta-adrenergic blockade and aspirin equivalently in African Americans and Caucasians. African Americans received thrombolysis less often according to the crude analysis. The multivariable analysis suggests less use of thrombolytics, even after adjusting for several covariates including indication by clinical algorithm. However, the small number of African-American patients deemed ideal candidates for thrombolysis attenuates the precision of this finding.