急性冠状动脉综合征患者在周末的死亡率是否高于工作日？美国人口、地理和时间趋势的综合分析

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-07-09 DOI:10.1002/clc.70175

Abdalhakim Shubietah, Abubakar Nazir, Mohamed S. Elgendy, Ameer Awashra, Jehad Zeidalkilani, Mohammad Alqadi, Suleiman Khreshi

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引用次数: 0

摘要

“周末效应”对美国急性冠脉综合征（ACS）死亡率的影响仍不确定。我们比较了周末和工作日的年龄调整死亡率（AAMRs），并分析了1999年至2020年的人口、地理和时间趋势。方法采用CDC WONDER (ICD-10: I20.0；I21.0-I21.4;I21.9;I22.0-I22.9;I24.8;I24.9)。原油和AAMRs（每10万）；2000年美国标准)，并通过连接点回归评估趋势，以估计年百分比变化（APCs）和平均APCs （AAPCs）。结果1999 - 2020年，ACS死亡病例3101 451例，工作日死亡病例2 222 468例(AAMR 46.4；95% CI 46.39-46.51)，周末878,983 (AAMR 18.4)，比例为2.5:1。这两个时期都出现了两个阶段的下降——2009-2010年之前的apc为≈ -6.4% /年，之后为-3.3 - -3.7% /年（p <； 0.001）。差异仍然存在：黑人成年人的AAMRs最高(周末20.9；53.2个工作日)，农村超过城市(28.7 vs 15.8；72.0 vs. 40.2)，男性超过女性(23.8 vs. 14.0；60.2 vs. 35.4)，随着年龄的增长，发病率急剧上升(周末0.3-223.0；工作日0.7 - -561.0)。2009年之后，下降速度放缓，2018年之后，黑人成年人平日死亡人数上升。结论周末对ACS死亡率的影响很小，工作日死亡人数远远超过周末死亡人数。种族、农村、性别和年龄之间持续存在（有时还在扩大）的差异凸显了以公平为重点的干预措施、加强农村心脏保健和有针对性的预防的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Do Patients With Acute Coronary Syndrome Face Higher Mortality on Weekends Versus Weekdays? A Comprehensive Analysis of Demographic, Geographic, and Temporal Trends in the United States

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Do Patients With Acute Coronary Syndrome Face Higher Mortality on Weekends Versus Weekdays? A Comprehensive Analysis of Demographic, Geographic, and Temporal Trends in the United States

Background

The impact of a “weekend effect” on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.

Methods

We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.0; I21.0–I21.4; I21.9; I22.0–I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).

Results

From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39–46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two-phase declines—APCs of ≈ –6.4%/year before 2009–2010 and –3.3 to –3.7%/year thereafter (all p <  0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3–223.0; weekday 0.7–561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.

Conclusions

The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent—and sometimes widening—disparities by race, rurality, sex, and age highlight the need for equity-focused interventions, strengthened rural cardiac care, and targeted prevention.

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.