Racial Disparities in Endovascular Aortic Aneurysm Repair
Racial Disparities in Endovascular Aortic Aneurysm Repair
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DOI：
10.1016/j.avsg.2018.11.002
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发表时间：
2019-04-01
影响因子：
1.5
通讯作者：
Nelson, Peter
中科院分区：
文献类型：
--
作者：
Tanious, Adam;Karunathilake, Nirmani;Nelson, Peter
背景：种族和民族差异是所有医学领域获得护理的一个关键问题。我们假设对全州行政数据集的分析将证明在获得这项最新技术以及血管内主动脉瘤修复 (EVAR) 后的相关结果方面存在基于种族的差异。方法：利用佛罗里达州卫生保健管理局的去识别化数据，我们根据国际疾病分类第九版修订程序代码识别出在 2000 年至 2014 年期间接受 EVAR 的患者。然后，我们将这些程序分配给这些程序的专业结果：我们在研究期间确定了 36,601 例 EVAR 手术。总样本的平均年龄为 73.38 岁 (+/- 9.87)，其中大多数为男性（n = 29,034，81.2%）。每个种族类别中的患者细分如下：17,056 名（47.7%）非西班牙裔白人、1,630 名（4.6%）非西班牙裔非裔美国人、16,431 名（46.0%）西班牙裔和 632 名（1.8%）被确定为“其他”的患者。数据分析显示，就诊年龄、患者性别和患者合并症评分之间存在显着差异。在总住院费用、住院时间、处置和付款人状况方面，不同种族的结果存在显着差异。结论：在 EVAR 治疗方面存在种族差异，非洲裔美国人需要干预的女性比例最高，住院时间最长，医疗补助支付来源最多，住院总费用最高，并且更有可能接受最高的西班牙裔医生治疗。与同龄人相比，他们的合并症评分更高，并且与非裔美国人一样，更有可能接受非血管外科医生的治疗。
Background: Racial and ethnic disparities are a critical issue in access to care within all fields of medicine. We hypothesized that analysis of a statewide administrative dataset would demonstrate disparities based on race with respect to access to this latest technology and the associated outcomes following endovascular aortic aneurysm repair (EVAR).Methods: Utilizing de-identified data from the Florida State Agency for Health Care Administration, we identified patients based on International Classification of Diseases Ninth Revision procedure codes who underwent EVAR between the years 2000 and 2014. We then assigned these procedures with the specialty of the operating physician and then analyzed outcomes based on the race of the patient.Results: We identified 36,601 EVAR procedures during the study period. The average age of the total sample was 73.38 (+/- 9.87), with the majority of the cohort being male (n = 29,034, 81.2%). Breakdown of patients within each race category was as follows: 17,056 (47.7%) non-Hispanic Whites, 1,630 (4.6%) non-Hispanic African Americans, 16,431 (46.0%) Hispanics, and 632 (1.8%) patients identified as "other.'' Data analysis showed significant differences among age at presentation, sex of patient, and comorbidity score of patients at presentation. There were significant differences in outcomes based on race with respect to total hospital charges, length of stay, disposition, and payer status.Conclusions: Racial disparities were discovered with respect to EVAR treatment. African Americans present at younger ages, have the highest percentage of females requiring intervention, have the longest hospital stays, have the highest Medicaid payer source, have the highest in-hospital total charges of any racial group, and are more likely to be treated by academic practitioners. Hispanics present with the highest comorbidity scores compared to their counterparts and, along with African Americans, are more likely to be treated by nonvascular surgeons.