Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011.
Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011.
复制标题
DOI：
10.1161/circoutcomes.114.001140
复制
发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Mody PS;Wang Y;Geirsson A;Kim N;Desai MM;Gupta A;Dodson JA;Krumholz HM
主动脉夹层（AD）的流行病学在美国老年人中尚未得到很好的描述。目前尚不清楚过去十年中阿尔茨海默病护理的进步是否伴随着结果的变化。2000年至2011年的住院医疗保险数据用于确定AD住院率的趋势。通过相应的生命状态档案确定死亡率。2000年至2011年间，共有32,057例阿尔茨海默病初次住院。阿尔茨海默病的总体住院率保持不变，为每10万人年10人。对于与AD相关的30天和1年死亡率，观察到的死亡率分别从31.8%下降到25.4%（差异为6.4%；95%可信区间[CI]， 6.2-6.5；校正后，6.4%;95% CI, 5.7-6.9）和从42.6%下降到37.4%（差异为5.2%;95% CI, 5.1-5.2；校正后，6.2%;95% CI, 5.3-6.7）。对于接受手术修复的A型夹层患者，观察到的30天死亡率从30.7%下降到21.4%（差异9.3%;95% CI, 8.3-10.2；校正后，7.3%;95% CI, 5.8-7.8），观察到的1年死亡率从39.9%下降到31.6%（差异8.3%;95% CI, 7.5-9.1%；校正后，8.2%;95% CI, 6.7 - 9.1）。B型夹层手术修复的30天死亡率从24.9%降至21%（差异为3.9%;95% CI, 3.5-4.2；校正后，2.9%;95% CI, 0.7-4.4）， 1年死亡率从36.4%降至32.5%（差异为3.9%;95% CI, 3.3-4.3；校正后，3.9%;95% CI, 2.5-6.3）。虽然阿尔茨海默病住院率保持稳定，但死亡率有所改善，特别是在接受手术修复的患者中。
The epidemiology of aortic dissection (AD) has not been well-described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32,057 initial AD hospitalizations were identified between 2000 and 2011. The overall hospitalization rate for AD remained unchanged at 10 per 100,000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2–6.5; adjusted, 6.4%; 95% CI, 5.7–6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1–5.2; adjusted, 6.2%; 95% CI, 5.3–6.7) respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3–10.2; adjusted, 7.3%; 95% CI, 5.8–7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5–9.1%; adjusted, 8.2%; 95% CI, 6.7 – 9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5–4.2; adjusted, 2.9%; 95% CI, 0.7–4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3–4.3; adjusted, 3.9%; 95% CI, 2.5–6.3) for surgical repair of type B dissection. While AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.