Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study
Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study
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DOI：
10.1136/bmj.327.7414.526
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发表时间：
2003-09-06
影响因子：
--
通讯作者：
Squire, IB
中科院分区：
文献类型：
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作者：
Blackledge, HM;Newton, J;Squire, IB
目的比较白人和南亚新入院心力衰竭患者的入院方式和预后，并评价个人特征和合并症对预后的影响。设计历史队列研究。设置联合王国地区卫生局（人口96万）。参与者5789例连续新入院的心力衰竭患者。主要结果测量人群入院率、首次入院心力衰竭发生率、生存率和再入院率。结果与白人相比，南亚患者的年龄调整入院率（男性为3.8，女性为5.2）和住院发生率（2.2和2.9）显著高于白人。在5789例心力衰竭病例中，南亚患者比白人患者更年轻，男性居多（70岁（SD 0.6））（78岁（SD 0.1））和56.5%(190/336)（49.3%(2494/5057)）。南亚患者也更可能有既往心肌梗死(10.1% （n = 34) upsilon 5.5% (n = 278)）或合并心肌梗死(18.8% （n = 63) upsilon 10.7% (n = 539)）或糖尿病(45.8% （n = 154) upsilon 16.2% (n = 817)，均P < 0.001）。在南亚患者中，男性和女性的未调整生存期都有延长的趋势。调整协变量后，南亚患者的死亡风险显著低于白人患者（风险比0.82,95%置信区间0.68 ~ 0.99），死亡或再入院概率相似（0.96,0.81 ~ 1.09）。结论：莱斯特郡南亚患者的心力衰竭入院率高于白人患者。第一次入院时，南亚患者比白人患者更年轻，更常伴有糖尿病或急性缺血性心脏病。尽管白人和南亚患者在个人特征和危险因素方面存在重大差异，但南亚患者的结果相似，甚至更好。
Objectives To compare patterns of admission to hospital and prognosis in white and South Asian patients newly admitted with heart failure, and to evaluate the effect of personal characteristics and comorbidity on outcome.Design Historical cohort study.Setting UK district health authority (population 960 000). Participants 5789 consecutive patients newly admitted with heart failure.Main outcome measures Population admission rates, incidence rates for first admission with heart failure, survival, and readmission rates.Results When compared with the white population, South Asian patients had significantly higher age adjusted admission rates (rate ratio 3.8 for men and 5.2 for women) and hospital incidence rates (2.2 and 2.9). Among 5789 incident cases of heart failure, South Asian patients were younger and more often male than white patients (70 (SD 0.6) upsilon 78 (SD 0.1) years and 56.5% (190/336) upsilon 49.3% (2494/5057)). South Asian patients were also more likely to have previous myocardial infarction (10.1% (n = 34) upsilon 5.5% (n = 278)) or concomitant myocardial infarction (18.8% (n = 63) upsilon 10.7% (n = 539)) or diabetes (45.8% (n = 154) upsilon 16.2% (n = 817), all P < 0.001). A trend was shown to longer unadjusted survival for both sexes among South Asian patients. After adjustment for covariables, South Asian patients had a significantly lower risk of death (hazard ratio 0.82, 95% confidence interval 0.68 to 0.99) and a similar probability of death or readmission (0.96, 0.81 to 1.09) compared with white patients.Conclusions Population admission rates for heart failure are higher among South Asian patients than white patients in Leicestershire. At first admission South Asian patients were younger and more often had concomitant diabetes or acute ischaemic heart disease than white patients. Despite major differences in personal characteristics and risk factors between white and South Asian patients, outcome was similar, if not better, in South Asian patients.