COVID-19 大流行期间急性冠状动脉综合征患者的性别和种族差异

Hearts Pub Date : 2024-01-12 DOI:10.3390/hearts5010004
Abdulmajeed Alharbi, Ahmed Elzanaty, Mohammad Safi, Momin Shah, Halah Alfatlawi, Zachary Holtzapple, Abed Jabr, Ehab Eltahawy
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Secondary outcomes encompassed the length of stay and hospital costs. The National Inpatient Sample (NIS) database was utilized to identify and study patients in our test group. Results: A total of 779,895 patients hospitalized with a primary diagnosis of acute coronary syndrome in the year 2020 and 935,975 patients in 2019 were included in this study. Baseline findings revealed that inpatient mortality was significantly higher in 2020 compared to 2019, regardless of sex and Ethnicity (adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) 1.12–1.23, p-value < 0.001). Concerning primary outcomes, there was no difference in inpatient mortality for hospitalized patients of different sexes between 2019 and 2020 (STEMI: aOR 1.05, 95% CI 0.96–1.14, p-value 0.22; NSTEMI/UA aOR 1.08, 95% CI 0.98–1.19, p-value 0.13). Regarding time to admission for PCI, NSTEMI/UA cases were found to be statistically significant in female patients compared to males (mean difference 0.06 days, 95% CI 0.02–0.10, p-value < 0.01) and African Americans compared to Caucasians (mean difference 0.13 days, 95% CI 0.06–0.19, p < 0.001). In terms of the length of stay, female patients had a shorter length of stay compared to males (mean difference −0.22, 95% CI −0.27 to −0.16, p-value < 0.01). Conclusions: As acute coronary syndrome is an urgent diagnosis, a global pandemic has the potential to exacerbate existing healthcare disparities related to sex and Ethnicity. This study did not reveal any difference in inpatient mortality, aligning with studies conducted prior to the pandemic. However, it highlighted significantly longer treatment times (admission to PCI) for NSTEMI/UA management in female and African American populations. 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引用次数: 0

摘要

导言:严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)于 2019 年在全球范围内流行。在此期间,住院率和死亡率出现了显著差异,尤其是在种族和性别方面。值得注意的是,本研究旨在探讨性别和种族对急性冠状动脉综合征结果的影响,尤其是在 SARS-CoV-2 全球大流行期间。研究方法这项回顾性观察研究分析了 2020 年在美国住院的主要诊断为急性冠状动脉综合征的成年患者。主要结果包括住院病人死亡率和从入院到经皮冠状动脉介入治疗(PCI)的时间。次要结果包括住院时间和住院费用。我们利用全国住院病人抽样(NIS)数据库来识别和研究测试组中的病人。研究结果本研究共纳入了 779,895 名 2020 年和 935,975 名 2019 年主要诊断为急性冠状动脉综合征的住院患者。基线研究结果显示,与 2019 年相比,2020 年的住院患者死亡率明显较高,与性别和种族无关(调整后的几率比(aOR)为 1.20,95% 置信区间(CI)为 1.12-1.23,P 值小于 0.001)。关于主要结局,2019 年和 2020 年期间,不同性别住院患者的住院死亡率没有差异(STEMI:aOR 1.05,95% CI 0.96-1.14,p 值 0.22;NSTEMI/UA aOR 1.08,95% CI 0.98-1.19,p 值 0.13)。在入院接受 PCI 治疗的时间方面,发现女性患者与男性患者(平均相差 0.06 天,95% CI 0.02-0.10,p 值<0.01)以及非裔美国人与白种人(平均相差 0.13 天,95% CI 0.06-0.19,p 值<0.001)相比,NSTEMI/UA 病例的入院时间具有统计学意义。就住院时间而言,女性患者的住院时间短于男性(平均差异为-0.22,95% CI为-0.27至-0.16,P值<0.01)。结论由于急性冠状动脉综合征是一种紧急诊断,因此全球大流行有可能加剧与性别和种族有关的现有医疗差距。这项研究没有发现住院病人死亡率有任何差异,这与大流行之前进行的研究一致。不过,该研究强调了女性和非裔美国人接受 NSTEMI/UA 治疗的治疗时间(从入院到 PCI)明显更长。这些研究结果表明,在大流行年期间,一些差异可能已经缩小,因此有必要在未来几年开展进一步研究,以确认这些趋势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sex and Ethnic Disparities during COVID-19 Pandemic among Acute Coronary Syndrome Patients
Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a global pandemic that emerged in 2019. During this period, a significant disparity in hospitalization and mortality rates emerged, particularly in terms of Ethnicity and sex. Notably, this study aims to examine the influence of sex and Ethnicity on acute coronary syndrome outcomes, specifically during the global SARS-CoV-2 pandemic. Methods: This retrospective observational study analyzed adult patients hospitalized with a primary diagnosis of acute coronary syndrome in the United States in 2020. Primary outcomes included inpatient mortality and the time from admission to percutaneous coronary intervention (PCI). Secondary outcomes encompassed the length of stay and hospital costs. The National Inpatient Sample (NIS) database was utilized to identify and study patients in our test group. Results: A total of 779,895 patients hospitalized with a primary diagnosis of acute coronary syndrome in the year 2020 and 935,975 patients in 2019 were included in this study. Baseline findings revealed that inpatient mortality was significantly higher in 2020 compared to 2019, regardless of sex and Ethnicity (adjusted odds ratio (aOR) 1.20, 95% confidence interval (CI) 1.12–1.23, p-value < 0.001). Concerning primary outcomes, there was no difference in inpatient mortality for hospitalized patients of different sexes between 2019 and 2020 (STEMI: aOR 1.05, 95% CI 0.96–1.14, p-value 0.22; NSTEMI/UA aOR 1.08, 95% CI 0.98–1.19, p-value 0.13). Regarding time to admission for PCI, NSTEMI/UA cases were found to be statistically significant in female patients compared to males (mean difference 0.06 days, 95% CI 0.02–0.10, p-value < 0.01) and African Americans compared to Caucasians (mean difference 0.13 days, 95% CI 0.06–0.19, p < 0.001). In terms of the length of stay, female patients had a shorter length of stay compared to males (mean difference −0.22, 95% CI −0.27 to −0.16, p-value < 0.01). Conclusions: As acute coronary syndrome is an urgent diagnosis, a global pandemic has the potential to exacerbate existing healthcare disparities related to sex and Ethnicity. This study did not reveal any difference in inpatient mortality, aligning with studies conducted prior to the pandemic. However, it highlighted significantly longer treatment times (admission to PCI) for NSTEMI/UA management in female and African American populations. These findings suggest that some disparities may have diminished during the pandemic year, warranting further research to confirm these trends in the years to come.
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