Race and cardiac catheterization use in the setting of acute myocardial infarctio

种族和心导管插入术在急性心肌梗塞中的应用

• 批准号: 7774706
• 负责人: SAIF SHAFIQUE RATHORE
• 金额: $ 3.48万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7774706
• 关键词: Race; cardiac; catheterization; use; setting

DESCRIPTION (provided by the applicant): Racial differences in the incidence, prevalence, and outcomes of cardiovascular disease in the United States are well documented. A possible contributing factor to poorer outcomes among black patients with heart disease may be lower rates of procedure use, including cardiac catheterization, compared with white patients. This hypothesis has its own series of unanswered questions. First, the accuracy of racial classification data in the majority of studies relies upon administrative data or other sources, which raises concerns of potential misclassification. The specific nature of this misclassification and its implications for reported rates of treatment and outcomes are unclear. Thus, I propose to compare patients' racial classification as documented in administrative sources vs. self-reported racial designation in the PREMIER registry, a national cohort of patients hospitalized for AMI. In addition to determining overall agreement of self vs. documented-race, correlates of concordance in racial designation will be identified, and associations of race (administrative vs. self-reported) association with treatment and outcomes will be determined and compared. Second, it is unclear whether racial variations in treatment, specifically cardiac catheterization postmyocardial infarction, reflect overtreatment of white patients, under-treatment of black patients, or a combination of processes. Thus, I will develop and validate a means for classifying patients' appropriateness of cardiac catheterization following myocardial infarction using data from the CCP, a national cohort of Medicare patients hospitalized for myocardial infarction between 1994 and 1996. Racial differences in cardiac catheterization use will be assessed overall and by patient appropriateness for cardiac catheterization to determine whether racial differences in treatment vary as a function of procedure appropriateness using hierarchical logistic regression analyses. Third, despite lower rates of treatment, elderly black patients with myocardial infarction are reported to have better outcomes, including lower mortality, than their white counterparts. It is unclear whether this pattern is limited to short-term follow-up or persists over longer follow-up. Accordingly, I will assess the long-term survival of black and white patients with myocardial infarction using patients in the CCP database, focusing on mortality and intermediate endpoints (hospitalization, development of additional cardiovascular comorbidities). The three projects are consonant with AHRQ's strategic research goals, including the identification of barriers to appropriate quality of care and assessment of health services use by an AHRQ priority population (minority patients). Further, the insights obtained from this project offer the potential to inform current AHRQ, purchaser, and provider efforts to address health and health care disparities. PUBLIC HEALTH RELEVANCE: The proposed work, an investigation of racial variations in the use of cardiac catheterization in patients with myocardial infarction, is consonant with AHRQ's research mission of understanding factors influencing access to quality health care, and addresses two priority populations, minority groups and the elderly. The proposal's three projects - rigorously evaluating the quality of race data reporting in administrative data and medical records; determining whether racial variations in cardiac catheterization use reflect overtreatment of white patients, undertreatment of black patients, or a combination of processes; and the impact of racial differences in cardiac catheterization use on long-term survival - will help inform current efforts to address racial disparities in health and health care use

描述（由申请方提供）：美国心血管疾病的发病率、患病率和结局存在种族差异，这一点已得到充分证明。与白色患者相比，黑人心脏病患者预后较差的一个可能因素可能是手术使用率较低，包括心导管插入术。这一假设本身也有一系列未解之谜。首先，大多数研究中种族分类数据的准确性依赖于行政数据或其他来源，这引起了对潜在错误分类的担忧。这种错误分类的具体性质及其对报告的治疗率和结局的影响尚不清楚。因此，我建议将管理来源中记录的患者种族分类与PREMIER登记处（一个因AMI住院的全国性患者队列）中自我报告的种族指定进行比较。除了确定自我与记录种族的总体一致性外，还将确定种族指定的一致性相关性，并确定和比较种族（管理与自我报告）与治疗和结局的相关性。其次，目前还不清楚治疗中的种族差异，特别是心肌梗死后的心导管插入术，是否反映了白色患者的过度治疗，黑人患者的治疗不足，或过程的组合。因此，我将开发并验证一种方法，用于使用CCP（1994年至1996年期间因心肌梗死住院的医疗保险患者的全国队列）的数据对心肌梗死后患者进行心导管插入术的适当性进行分类。将使用分层逻辑回归分析，对心导管插入术使用中的种族差异进行总体评估，并根据患者的心导管插入术适当性进行评估，以确定治疗中的种族差异是否随手术适当性而变化。第三，尽管治疗率较低，但据报道，老年黑人心肌梗死患者的预后比白色患者好，包括死亡率低。目前尚不清楚这种模式是否仅限于短期随访或持续较长的随访。因此，我将使用CCP数据库中的患者评估黑人和白色心肌梗死患者的长期生存率，重点关注死亡率和中间终点（住院、其他心血管合并症的发生）。这三个项目符合AHRQ的战略研究目标，包括确定妨碍适当质量护理的障碍，以及评估AHRQ优先人群（少数民族患者）使用保健服务的情况。此外，从这个项目中获得的见解提供了潜在的信息，目前AHRQ，购买者和提供者的努力，以解决健康和医疗保健的差距。 公共卫生相关性：拟议的工作，在心肌梗死患者使用心导管的种族差异的调查，是符合AHRQ的研究使命的理解因素影响获得优质的医疗保健，并解决两个优先人群，少数群体和老年人。该提案的三个项目-严格评估行政数据和医疗记录中种族数据报告的质量;确定心脏导管插入术使用的种族差异是否反映了对白色患者的过度治疗，对黑人患者的治疗不足，或过程的组合;以及心脏导管插入术使用的种族差异对长期生存率的影响-将有助于为当前解决健康和医疗保健使用方面的种族差异的努力提供信息