Trends in Racial and Ethnic Disparities in the Receipt of Lifesaving Procedures for Hospitalized Patients With Decompensated Cirrhosis in the US, 2009-2018.
Trends in Racial and Ethnic Disparities in the Receipt of Lifesaving Procedures for Hospitalized Patients With Decompensated Cirrhosis in the US, 2009-2018.
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DOI：
10.1001/jamanetworkopen.2023.24539
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发表时间：
2023-07-03
影响因子：
13.8
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在美国，按种族和民族划分的失代偿期肝硬化住院患者接受手术的趋势是什么？在这项横断面研究中，717 580例失代偿性肝硬化住院患者中，截至2018年，接受上消化道内镜检查治疗静脉曲张出血的患者没有种族差异;然而，与白色患者相比，黑人患者接受经颈静脉门体分流术治疗静脉曲张出血和腹水的可能性仍然较低。2018年，黑人和西班牙裔患者接受肝移植的可能性仍然较低，黑人患者的死亡几率更高。这些研究结果表明，随着时间的推移，美国在接受复杂的救生程序和死亡率方面的种族和民族差异持续存在。这项横断面研究评估了2009年至2018年美国按人种和种族接受失代偿期肝硬化治疗的趋势。失代偿性肝硬化患者住院接受紧急治疗，并采取临时和挽救生命的措施。为这一领域的干预发展提供信息而公布的数据已有十多年的历史，目前尚不清楚随着时间的推移，在接受这些程序方面的差距是否有所改善。评价人种和种族与美国失代偿期肝硬化治疗程序随时间推移的相关性。这项回顾性横断面研究分析了2009年至2018年门脉高压相关并发症患者肝硬化入院的全国住院患者样本数据。评估了2009年至2018年18岁及以上人群的所有出院情况。如果包含至少1个与糖尿病相关的国际疾病分类，第九次修订，临床修改，则纳入住院病例（ICD-9-CM）或国际疾病统计分类，第十修订版，临床修订版（ICD-10-CM）代码和至少1个与膀胱炎相关的并发症ICD-9-CM或ICD-10-CM代码（即腹水、肝性脑病、静脉曲张出血[VH]和肝肾综合征[HRS]）。数据分析时间为2022年1月至6月。因失代偿性肝硬化住院。关注的结局是失代偿性肝硬化接受手术（上消化道内镜检查、经颈静脉门体分流术[TIPS]、血液透析和肝移植[LT]）的比值比（OR）趋势以及按人种和种族划分的死亡率，随时间建模。多变量logistic回归用于评估这些结果。在717 580例住院患者（中位[IQR]年龄为58 [52-67]岁）中，345 644例患者（9.8%）为黑人，623 991例患者（17.6%）为西班牙裔，2 340 031例患者（47.4%）为白色。根据建模趋势，到2018年，不同人种或种族接受上消化道内窥镜检查治疗VH的几率无显著差异。然而，黑人患者接受TIPS治疗VH（OR，0.54; 95% CI，0.47-0.62）和腹水（OR，0.34; 95% CI，0.31-0.38）的可能性仍然低于白色患者。在研究期间，黑人和西班牙裔患者接受LT的差异有所改善;然而，到2018年，两组接受LT的可能性仍然低于白色患者（黑人：OR，0.66; 95% CI，0.61-0.70;西班牙裔：OR，0.74; 95% CI，0.70-0.78）。研究期间，黑人和西班牙裔患者的死亡几率下降，但2018年黑人患者的死亡几率仍然高于白色患者（OR，1.08; 95%CI，1.05-1.11）。在这项对失代偿期肝硬化住院患者的横断面研究中，在接受复杂的救生程序和死亡率方面存在种族和民族差异，这些差异随着时间的推移而持续存在。
What are the trends in receipt of procedures for hospitalized patients with decompensated cirrhosis by race and ethnicity in the United States? In this cross-sectional study 717 580 admissions for decompensated cirrhosis, there were no racial disparities in receipt of upper endoscopy for variceal hemorrhage by 2018; however, compared with White patients, Black patients remained less likely to receive transjugular portosystemic shunt for variceal hemorrhage and ascites. In 2018, both Black and Hispanic patients remained less likely to receive liver transplant, and Black patients had higher odds of death. These findings suggest that racial and ethnic disparities in receipt of complex life-saving procedures and in mortality in the US persisted over time. This cross-sectional study evaluates trends in receipt of procedures to treat decompensated cirrhosis by race and ethnicity from 2009 to 2018 in the US. Patients with decompensated cirrhosis are hospitalized for acute management with temporizing and lifesaving procedures. Published data to inform intervention development in this area are more than a decade old, and it is not clear whether there have been improvements in disparities in the receipt of these procedures over time. To evaluate the associations of race and ethnicity with receipt of procedures to treat decompensated cirrhosis over time in the US. This retrospective cross-sectional study analyzed National Inpatient Sample data on cirrhosis admissions among patients with portal hypertension–related complications from 2009 to 2018. All hospital discharges for individuals aged 18 years and older from 2009 to 2018 were assessed for inclusion. Admissions were included if they contained at least 1 cirrhosis-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code and at least 1 cirrhosis-related complication ICD-9-CM or ICD-10-CM code (ie, ascites, hepatic encephalopathy, variceal hemorrhage [VH], and hepatorenal syndrome [HRS]). Data were analyzed from January to June 2022. Hospitalization for decompensated cirrhosis. The outcomes of interest were trends in the odds ratios (ORs) for receiving procedures (upper endoscopy, transjugular portosystemic shunt [TIPS], hemodialysis, and liver transplantation [LT]) for decompensated cirrhosis and mortality by race and ethnicity, modeled over time. Multivariable logistic regression was used to assess these outcomes. Among 717 580 admissions (median [IQR] age, 58 [52-67] years), 345 644 patients (9.8%) were Black, 623 991 patients (17.6%) were Hispanic, and 2 340 031 patients (47.4%) were White. Based on the modeled trends, by 2018, there were no significant differences by race or ethnicity in the odds of receiving upper endoscopy for VH. However, Black patients remained less likely than White patients to undergo TIPS for VH (OR, 0.54; 95% CI, 0.47-0.62) and ascites (OR, 0.34; 95% CI, 0.31-0.38). The disparity in receipt of LT improved for Black and Hispanic patients over the study period; however, by 2018, both groups remained less likely to undergo LT than their White counterparts (Black: OR, 0.66; 95% CI, 0.61-0.70; Hispanic: OR, 0.74; 95% CI, 0.70-0.78). The odds of death in Black and Hispanic patients declined over the study period but remained higher in Black patients than White patients in 2018 (OR, 1.08; 95% CI, 1.05-1.11). In this cross-sectional study of individuals hospitalized with decompensated cirrhosis, there were racial and ethnic disparities in receipt of complex lifesaving procedures and in mortality that persisted over time.