美国肺动脉高压的区域差异:肺动脉高压协会注册。

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM
Connor Fling, Teresa De Marco, Noah A Kime, Matthew R Lammi, Laura J Oppegard, John J Ryan, Corey E Ventetuolo, R James White, Roham T Zamanian, Peter J Leary
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引用次数: 0

摘要

理由:肺动脉高压(PAH)是一种具有复杂诊断和治疗环境的异质性疾病。其他复杂的心肺疾病在特征和结果上有很大的区域差异;然而,这在以前的多环芳烃文献中没有描述过。目的:确定肺动脉高压协会登记(PHAR)参与者的特征和结果在美国人口普查地区之间的基线差异。方法:将患有多环芳烃的成人按地区分组(东北部、南部、中西部和西部),并给出普查地区之间的基线差异。使用Kaplan-Meier生存分析和Cox比例风险来估计未调整和调整模型中地区与死亡率之间的关系。结果:人口普查地区在年龄、种族、民族、婚姻状况、就业、保险付款明细、积极吸烟和当前饮酒方面存在实质性差异。PAH病因和基线6分钟步行距离测试结果也存在差异。治疗特征因人口普查地区而异,西部PHAR参与者的死亡率似乎更低(风险比,0.60;95%置信区间为0.43 ~ 0.83,P = 0.005)。这种差异不能用人口统计学特征、多环芳烃病因、基线严重程度、基线用药方案或疾病患病率的差异来解释。结论:目前的研究表明,在认可的肺血管疾病中心的参与者中,多项基线特征和死亡率存在显著的区域差异。这种差异可能会对临床研究计划产生影响,并代表了进一步研究的重要焦点,以更好地了解是否存在可补救的护理方面,这些方面可以在美国追求提供公平的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Regional Variation in Pulmonary Arterial Hypertension in the United States: The Pulmonary Hypertension Association Registry.

Rationale: Pulmonary arterial hypertension (PAH) is a heterogeneous disease within a complex diagnostic and treatment environment. Other complex heart and lung diseases have substantial regional variation in characteristics and outcomes; however, this has not been previously described in PAH. Objectives: To identify baseline differences between U.S. census regions in the characteristics and outcomes for participants in the Pulmonary Hypertension Association Registry (PHAR). Methods: Adults with PAH were divided into regional groups (Northeast, South, Midwest, and West), and baseline differences between census regions were presented. Kaplan-Meier survival analyses and Cox proportional hazards were used to estimate the association between region and mortality in unadjusted and adjusted models. Results: Substantial differences by census regions were seen in age, race, ethnicity, marital status, employment, insurance payor breakdown, active smoking, and current alcohol use. Differences were also seen in PAH etiology and baseline 6-minute walk distance test results. Treatment characteristics varied by census region, and mortality appeared to be lower in PHAR participants in the West (hazard ratio, 0.60; 95% confidence interval, 0.43-0.83, P = 0.005). This difference was not readily explained by differences in demographic characteristics, PAH etiology, baseline severity, baseline medication regimen, or disease prevalence. Conclusions: The present study suggests significant regional variation among participants at accredited pulmonary vascular disease centers in multiple baseline characteristics and mortality. This variation may have implications for clinical research planning and represent an important focus for further study to better understand whether there are remediable care aspects that can be addressed in the pursuit of providing equitable care in the United States.

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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
发文量
0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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