低社会经济地位与减少获得利钠肽测试在门诊设置：基于人群的评估

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.002

Ismail R. Raslan MD, MSc , Anna Chu MHSc , Peter C. Austin PhD , Xuesong Wang MSc , David Bobrowski MD , Barbara S. Doumouras MD , Joseph J. Lee BSc , Candace D. McNaughton MD, PhD , Peter A. Kavsak PhD , Husam Abdel-Qadir MD, PhD , Heather J. Ross MD, MHSc , Douglas S. Lee MD, PhD

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引用次数: 0

摘要

背景：在心力衰竭（HF）的诊断和预后中，利钠肽（NP）浓度测试是指南推荐的。虽然在一些医院可以进行NP检测，但只有那些能够自掏腰包的人才有机会进行门诊检测。我们调查了社会经济地位较低的居民是否有不同的NP测试机会。方法采用病例对照设计，我们比较了在门诊或急性医院进行NP检查的患者与年龄匹配的非NP血液检查患者（2015年1月- 2020年6月）。社会经济地位测量（例如，剥夺五分位数）与接受NP测试的关系使用条件逻辑回归进行评估，调整性别、测试地点和合并症，并根据既往心衰发生率分层。结果：96,919例既往无HF的患者(中位年龄72岁；50%的女性)接受NP检测，大多数检测（66.6%）是在急症医院进行的，而不是在门诊进行的。较贫困社区的居民HF发病率较高(P <；0.001)，但他们更有可能在急性护理环境中接受NP测试(最贫困与最贫困的比值比[OR]为1.269；95%可信区间[CI]， 1.104-1.216)，作为门诊患者接受检测的可能性较小(OR, 0.807；95% CI, 0.764-0.853 vs最贫困人群；所有P <；0.001)。70362例匹配的已知HF患者(中位年龄78岁；45%女性)，门诊NP检测在生活在最贫困社区的患者中也不太可能进行(OR, 0.723；95% ci, 0.677-0.772；P & lt;0.001)。结论：尽管社会经济地位较低的人发生心衰的风险较高，但他们在门诊进行的NP检测较少，而在资源紧张的急症护理机构进行的NP检测较多。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Low Socioeconomic Status Is Associated with Reduced Access to Natriuretic Peptide Testing in the Outpatient Setting: A Population-based Evaluation

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Low Socioeconomic Status Is Associated with Reduced Access to Natriuretic Peptide Testing in the Outpatient Setting: A Population-based Evaluation

Background

Tests of natriuretic peptide (NP) concentrations are guideline-recommended for diagnosis and prognostication in heart failure (HF). Although NP testing is available at some hospitals, outpatient access has been limited to those who can pay out-of-pocket. We investigated whether residents who have lower socioeconomic status have differential access to NP testing.

Methods

Using a case-control design, we compared patients who had NP tests with age-matched patients undergoing non-NP blood tests (January 2015-June 2020), performed in the outpatient or acute hospital setting. The association of socioeconomic status measures (eg, deprivation quintile) with receipt of NP testing was assessed using conditional logistic regression, adjusted for sex, test location, and comorbidities, and was stratified by incidence of prior HF.

Results

Among 96,919 patients without prior HF (median age, 72 years; 50% female) who underwent NP testing, the majority of tests (66.6%) were performed in an acute hospital setting rather than in an outpatient clinic. Residents of more-deprived neighbourhoods had a higher incidence of HF (P < 0.001), but they were more likely to undergo NP testing in an acute care setting (odds ratio [OR] for most- vs least-deprived, 1.269; 95% confidence interval [CI], 1.104-1.216) and less likely to undergo testing as outpatients (OR, 0.807; 95% CI, 0.764-0.853 vs least-deprived; all P < 0.001). Among 70,362 matched patients with known HF (median aged, 78 years; 45% female), outpatient NP testing was also less likely to be performed among patients living in the most-deprived neighbourhoods (OR, 0.723; 95% CI, 0.677-0.772; P < 0.001).

Conclusions

Although those of lower socioeconomic status exhibit a higher risk of incident HF, they had less NP testing performed in outpatient settings, and more testing performed in resource-intense acute-care settings.

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