Disparities in the treatment and outcomes of vascular disease in Hispanic patients
Disparities in the treatment and outcomes of vascular disease in Hispanic patients
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DOI：
10.1016/j.jvs.2007.07.021
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发表时间：
2007-11-01
影响因子：
4.3
通讯作者：
Greco, Giampaolo
中科院分区：
文献类型：
--
作者：
Morrissey, Nicholas J.;Giacovelli, Jeannine;Greco, Giampaolo
背景：西班牙裔人口是美国增长最快的少数民族。随着人口的增长和老龄化，血管外科界将为这个多样化的群体提供越来越多的护理。为了适当地管理预防和治疗护理，重要的是要了解的发病率，危险因素，血管疾病的自然史在西班牙裔patients.Methods：我们分析了出院数据库从纽约和佛罗里达，以确定下肢血运重建（LER），颈动脉血运重建（CR），腹主动脉瘤（AAA）修复率在西班牙裔相对于一般人群。确定了与首次手术相同住院期间的常见合并症发生率、手术适应症和结局。多变量逻辑回归分析用于确定西班牙裔和白色非西班牙裔之间在手术率、就诊症状和术后结局方面的差异。人口统计学变量和住院时间也进行了分析。西班牙裔患者的LER、CR和AAA修复率显著低于白色非西班牙裔患者。尽管干预率较低，但西班牙裔人比白人更容易出现威胁肢体的下肢缺血（比值比[OR]，2.09; 95%置信区间[CI]，1.91 - 2.29），症状性颈动脉疾病（OR，1.57; 95% CI，1.4 - 1.75）和AAA破裂（OR，1.26; 95% CI，1.04-1.52）的风险高于非西班牙裔白色人。西班牙裔患者在LER后同一住院期间截肢率较高（6.2% vs 3.4%，P <0.0001），择期AAA修复术后死亡率较高（5% vs 3.4%，P = 0.0032）。LER，CR和AAA修复后的住院时间较长的西班牙裔患者比白色非西班牙裔。结论：西班牙裔患者和一般人群之间存在显着差异的三种常见的血管外科手术的利用率。此外，西班牙裔似乎目前与更先进的疾病，并在某些情况下有更糟糕的结果。必须确定造成这些差距的原因，以改善我们社会增长最快的部分的这些结果。
Background: The Hispanic population represents the fastest growing minority in the United States. As the population grows and ages, the vascular surgery community will be providing increasing amounts of care to this diverse group. To appropriately administer preventive and therapeutic care, it is important to understand the incidence, risk factors, and natural history of vascular disease in Hispanic patients.Methods: We analyzed hospital discharge databases from New York and Florida to determine the rate of lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic aneurysm (AAA) repair in Hispanics relative to the general population. The rates of common comorbidities, the indications for the procedures, and outcomes during the same hospitalization as the index procedure were determined. Multivariate logistic regression analysis was used to determine the differences between Hispanics and white non-Hispanics with respect to rate of procedure, symptoms at presentation, and outcome after procedure. Demographic variables and length of stay were also analyzed.Results. The rate of LER, CR, and AAA repair was significantly lower in Hispanic patients than in white non-Hispanics. Despite this lower rate of intervention, Hispanics were significantly more likely than whites to present with limb-threatening lower extremity ischemia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.91 to 2.29), symptomatic carotid artery disease (OR, 1.57; 95% CI, 1.4 to 1.75), and ruptured AAA (OR, 1.26; 95% CI, 1.04-1.52) than white non-Hispanics These differences were maintained after controlling for the presence of diabetes mellitus and other comorbidities. Hispanic patients had higher rates of amputation during the same hospitalization after LER (6.2% vs 3.4%, P < .0001) and higher mortality after elective AAA repair (5% vs 3.4%, P = .0032). Length of stay after LER, CR, and AAA repair was longer for Hispanic patients than white non-Hispanics.Conclusion: Significant disparities in the rate of utilization of three common vascular surgical procedures exist between Hispanic patients and the general population. In addition, Hispanics appear to present with more advanced disease and have worse outcomes in some cases. Reasons for these disparities must be determined to improve these results in the fastest growing segment of our society.