英国急性冠状动脉综合征血运重建和预后不平等的交叉性:全国范围内的相关队列研究。

IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Marius Roman, Ann Cheng, Florence Y Lai, Hardeep Aujla, Julie Sanders, Jeremy Dearling, Sarah Murray, Mahmoud Loubani, Vijay Kunadian, Chris Gale, Gavin J Murphy
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引用次数: 0

摘要

背景:生活在社会贫困地区的妇女、非白种人以及具有多种长期条件的人在获得护理方面的不平等导致了结果的不平等。我们调查了急性冠脉综合征(ACS)入院的冠状动脉血管重建和临床结果的这些健康不平等原因的交叉性。方法:我们纳入了2015年4月至2018年4月期间英国各类急性冠状动脉综合征的住院情况,并将医院发作统计数据与英国国家统计局的死亡率数据联系起来。主要终点是全因死亡率的时间。时间-事件分析研究了性别、种族和社会经济剥夺与血管重建的关系。结果:428700例ACS入院患者中,21215例(48.8%)在30天内接受了血运重建。女性、黑人、多病和体弱患者接受血管重建的可能性较小。南亚族裔的血运重建率(HR = 1.15, 95% CI 1.14-1.17)更高,风险调整后的生存率也更高,但与其他族裔相比,再入院率更高。女性1年全因死亡率更高(25.5% vs 14.7%-STEMI;24.9% vs 18.7%-非stemi)和心血管(22.6% vs 13.2%-STEMI;20.3% vs 15.6% (nstemi)的死亡率高于男性。在调整混杂因素后,女性的全因死亡率低于男性。讨论:归因于女性和南亚种族人群的结果可能归因于年龄、合并症和就诊时的虚弱。黑人种族、地理和社会剥夺可能是不平等的根源。这些发现突出了未满足的需求,并可能为解决不平等问题的干预措施提供潜在目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England: nationwide linked cohort study.

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England: nationwide linked cohort study.

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England: nationwide linked cohort study.

Intersectionality of inequalities in revascularization and outcomes for acute coronary syndrome in England: nationwide linked cohort study.

Background: Inequalities in access to care for women, people of non-white ethnicity, who live in areas of social deprivation, and with multiple long-term conditions lead to inequity of outcomes. We investigated the intersectionality of these causes of health inequality on coronary revascularization and clinical outcomes for admissions with acute coronary syndrome (ACS).

Methods and results: We included hospital admissions in England for types of ACS from April 2015 to April 2018 and linked Hospital Episode Statistics to the Office for National Statistics mortality data. The primary outcome was time to all-cause mortality. Time-to-event analyses examined the associations of sex, ethnicity, and socioeconomic deprivation with revascularization. Of 428 700 admissions with ACS, 212 015 (48.8%) received revascularization within 30 days. Women, black ethnicity, multimorbid, and frail patients were less likely to undergo revascularization. South Asian ethnicities had higher [hazard ratio (HR) = 1.15, 95% confidence interval (CI) 1.14-1.17] revascularization rates and comparable risk-adjusted survival but higher re-admission rates when compared to other ethnic groups. Women had higher 1-year all-cause [25.5% vs. 14.7%-ST-elevation myocardial infarction (STEMI); 24.9% vs. 18.7%-non-ST-elevation myocardial infarction (NSTEMI)] and cardiovascular (22.6% vs. 13.2%-STEMI; 20.3% vs. 15.6%-NSTEMI) mortality than men. After adjusting for confounders, women had a lower all-cause mortality when compared to men.

Discussion: Outcomes attributed to women and people of South Asian ethnicity may be attributable to age, comorbidity and frailty at presentation. Black ethnicity, geography, and social deprivation may be sources of inequality. These findings highlight the unmet need and may provide potential targets for interventions that address inequalities.

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来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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