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Annesi CA, Gillis A, Fazendin JM, Lindeman B, Chen H. Same-day parathyroidectomy for primary hyperparathyroidism -an over 20-year practice. World J Surg 2024. [PMID: 39174347 DOI: 10.1002/wjs.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION There has been a shift in recent years toward same-day parathyroidectomies due to the decrease in mutual costs with few significant differences in postoperative morbidity or mortality. We sought to determine if demographics, preoperative patient risk factors, or comorbidities were associated with a patient's likelihood of having same-day or inpatient surgery. MATERIALS AND METHODS A prospective database of parathyroid operations from 2001 to 2022 (n = 2948 patients) was reviewed for surgeries completed for primary hyperparathyroidism. Patients were categorized as same-day or inpatient surgery; demographics, risk factors, and co-morbidities were examined and differences across practice patterns during the 21-year period were studied and also analyzed in a subset of patients from 2013 to 2022. RESULTS In a recent subset of patients from 2013 to 2022, patients having inpatient surgery were more likely to be Black and use anticoagulation or antiplatelet therapy. Multivariable regression confirmed increased odds of aging and black patients requiring inpatient parathyroidectomy. Compared to 2001-2003, there was a significantly increased proportion of patients undergoing same-day surgery; compared to 2010-2012, there was a similar proportion of patients undergoing outpatient surgery between 2013 and 2018, and there was an increased proportion from 2019 through 2022. CONCLUSION Same-day parathyroidectomies have been shown to be safe and has become the typical practice for high-volume parathyroid surgeons over the last decade. Complications such as postoperative hematoma or hypocalcemia were previously shown to be incompletely mitigated by increased LOS or inpatient surgery, although demographics are considered to increase the odds of inpatient parathyroidectomy.
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Affiliation(s)
- Chandler A Annesi
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica M Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Scott SS, Gouchoe DA, Azap L, Henn MC, Choi K, Mokadam NA, Whitson BA, Pawlik TM, Ganapathi AM. Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery. CURRENT CARDIOVASCULAR RISK REPORTS 2024; 18:95-113. [PMID: 39100592 PMCID: PMC11296970 DOI: 10.1007/s12170-024-00739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Purpose of Review Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support. Recent Findings Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics. Summary Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.
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Affiliation(s)
- Shane S. Scott
- Medical Scientist Training Program, Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH USA
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Doug A. Gouchoe
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Lovette Azap
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Matthew C. Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Kukbin Choi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Nahush A. Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Asvin M. Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
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Liu J, Zhong H, Reynolds M, Illescas A, Cozowicz C, Wu CL, Poeran J, Memtsoudis S. Evidence-based Perioperative Practice Utilization among Various Racial Populations-A Retrospective Cohort Trending Analysis of Lower Extremity Total Joint Arthroplasty Patients. Anesthesiology 2023; 139:769-781. [PMID: 37651453 DOI: 10.1097/aln.0000000000004755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Various studies have demonstrated racial disparities in perioperative care and outcomes. The authors hypothesize that among lower extremity total joint arthroplasty patients, evidence-based perioperative practice utilization increased over time among all racial groups, and that standardized evidence-based perioperative practice care protocols resulted in reduction of racial disparities and improved outcomes. METHODS The study analyzed 3,356,805 lower extremity total joint arthroplasty patients from the Premier Healthcare database (Premier Healthcare Solutions, Inc., USA). The exposure of interest was race (White, Black, Asian, other). Outcomes were evidence-based perioperative practice adherence (eight individual care components; more than 80% of these implemented was defined as "high evidence-based perioperative practice"), any major complication (including acute renal failure, delirium, myocardial infarction, pulmonary embolism, respiratory failure, stroke, or in-hospital mortality), in-hospital mortality, and prolonged length of stay. RESULTS Evidence-based perioperative practice adherence rate has increased over time and was associated with reduced complications across all racial groups. However, utilization among Black patients was below that for White patients between 2006 and 2021 (odds ratio, 0.94 [95% CI, 0.93 to 0.95]; 45.50% vs. 47.90% on average). Independent of whether evidence-based perioperative practice components were applied, Black patients exhibited higher odds of major complications (1.61 [95% CI, 1.55 to 1.67] with high evidence-based perioperative practice; 1.43 [95% CI, 1.39 to 1.48] without high evidence-based perioperative practice), mortality (1.70 [95% CI, 1.29 to 2.25] with high evidence-based perioperative practice; 1.29 [95% CI, 1.10 to 1.51] without high evidence-based perioperative practice), and prolonged length of stay (1.45 [95% CI, 1.42 to 1.48] with high evidence-based perioperative practice; 1.38 [95% CI, 1.37 to 1.40] without high evidence-based perioperative practice) compared to White patients. CONCLUSIONS Evidence-based perioperative practice utilization in lower extremity joint arthroplasty has been increasing during the last decade. However, racial disparities still exist with Black patients consistently having lower odds of evidence-based perioperative practice adherence. Black patients (compared to the White patients) exhibited higher odds of composite major complications, mortality, and prolonged length of stay, independent of evidence-based perioperative practice use, suggesting that evidence-based perioperative practice did not impact racial disparities regarding particularly the Black patients in this surgical cohort. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
| | - Michael Reynolds
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
| | - Alex Illescas
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/ Department of Orthopedics/Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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Rotar EP, Scott EJ, Hawkins RB, Mehaffey JH, Strobel RJ, Charles EJ, Quader MA, Joseph M, Teman NR, Yarboro LT, Ailawadi G. Changes in Controllable Coronary Artery Bypass Grafting Practice for White and Black Americans. Ann Thorac Surg 2023; 115:922-928. [PMID: 35093386 DOI: 10.1016/j.athoracsur.2021.11.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 11/07/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Racial disparities in outcomes after cardiac surgery are well reported. We sought to determine whether variation by race exists in controllable practices during coronary artery bypass graft surgery (CABG). We hypothesized that racial disparities exist in CABG quality metrics, but have improved over time. METHODS All patients undergoing isolated CABG (2000 to 2019) in a multiple state database were stratified into three eras by race. Analysis included propensity matched White Americans and Black Americans. Primary outcomes included left internal mammary artery use, multiple arterial grafting, revascularization completeness, and guideline-directed medication prescription. RESULTS Of 72 248 patients undergoing CABG, Black American patients (n = 10 270, 15%) had higher rates of diabetes mellitus, hypertension, prior stroke, and myocardial infarction. After matching, 19 806 patients (n = 9903 per group) were well balanced. Left internal mammary artery use was significantly different early (era 1, Black Americans 84.7% vs White Americans 86.6%; P = .03), but equalized over time. Importantly, multiarterial grafting differed between Black Americans and White Americans over the entire study (9.1% vs 11.5%, P < .001) and within each era. Black Americans had more incomplete revascularization during the study period (14% vs 12.8%, P = .02) driven by a large disparity in era 1 (9.5% vs 7.2%, P < .001). Despite similar rates of preoperative use, Black Americans were more often discharged on a regimen of β-blockers (91.8% vs 89.6%, P < .001). CONCLUSIONS Coronary artery bypass graft surgery metrics of left internal mammary artery use and optimal medical therapy have improved over time and are similar despite patient race. Black Americans undergo less frequent multiarterial grafting and greater discharge β-blocker prescription. Identifying changes in controllable CABG quality practices across races supports a continued focus on standardizing such efforts.
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Affiliation(s)
- Evan P Rotar
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Erik J Scott
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - J Hunter Mehaffey
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eric J Charles
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Joseph
- Division of Cardiothoracic Surgery, Virginia Tech Carillion School of Medicine, Roanoke, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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Cui HL, Wei JP. Progress in research of enhanced recovery after surgery and surgery related differences. Shijie Huaren Xiaohua Zazhi 2020; 28:144-148. [DOI: 10.11569/wcjd.v28.i4.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Enhanced recovery after surgery (ERAS) refers to the use of standardized, multimodal perioperative strategies to reduce physiological stress and organ dysfunction caused by surgery. Since the ERAS concept was put forward, it has been widely respected in the surgical field. Its benefits in the surgical field for the vast majority of patients, medical staff and healthcare systems are obvious. However, for some specific people undergoing surgery, the benefits are not certain, which is the so-called surgery-related differences. This article analyzes recent studies of different surgical fields related to surgical-related differences in different ethnic groups, reviews a large number of positive effects of the implementation of ERAS on surgical-related differences, and elaborates its possible mechanism. It is finally concluded that ERAS, a standardized model for resolving surgical-related differences, should become the gold standard for surgical perioperative management.
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Affiliation(s)
- Hong-Li Cui
- Department of General Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China
| | - Jin-Ping Wei
- Department of General Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing 100022, China
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Becker ER, Granzotti AM. Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain? J Natl Med Assoc 2019; 111:527-539. [DOI: 10.1016/j.jnma.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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7
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Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis. J Thorac Cardiovasc Surg 2019; 157:2216-2225.e4. [DOI: 10.1016/j.jtcvs.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 01/13/2023]
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8
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Marques IC, Wahl TS, Chu DI. Enhanced Recovery After Surgery and Surgical Disparities. Surg Clin North Am 2018; 98:1223-1232. [DOI: 10.1016/j.suc.2018.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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9
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The Racial Paradox in Multiarterial Conduit Utilization for Coronary Artery Bypass Grafting. Ann Thorac Surg 2017; 103:1214-1221. [DOI: 10.1016/j.athoracsur.2016.07.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/17/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022]
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Elsamadicy AA, Adogwa O, Sergesketter A, Hobbs C, Behrens S, Mehta AI, Vasquez RA, Cheng J, Bagley CA, Karikari IO. Impact of Race on 30-Day Complication Rates After Elective Complex Spinal Fusion (≥5 Levels): A Single Institutional Study of 446 Patients. World Neurosurg 2017; 99:418-423. [DOI: 10.1016/j.wneu.2016.12.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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Racial/Ethnic Disparities in Perioperative Outcomes of Major Procedures: Results From the National Surgical Quality Improvement Program. Ann Surg 2016; 262:955-64. [PMID: 26501490 DOI: 10.1097/sla.0000000000001078] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the association between race/ethnicity and perioperative outcomes in individuals undergoing major oncologic and nononcologic surgical procedures in the United States. BACKGROUND Prior work has shown that there are significant racial/ethnic disparities in perioperative outcomes after several types of major cardiac, general, vascular, orthopedic, and cancer surgical procedures. However, recent evidence suggests attenuation of these racial/ethnic differences, particularly at academic institutions. METHODS We utilized the American College of Surgeons National Surgical Quality Improvement Program database to identify 142,344 patients undergoing one of the 16 major cancer and noncancer surgical procedures between 2005 and 2011. RESULTS Eighty-five percent of the cohort was white, with black and Hispanic individuals comprising 8% and 4%, respectively. In multivariable analyses, black patients had greater odds of experiencing prolonged length of stay after 10 of the 16 procedures studied (all P < 0.05), though there was no disparity in odds of 30-day mortality after any surgery. Hispanics were more likely to experience prolonged length of stay after 5 surgical procedures (all P < 0.04), and were at greater odds of dying within 30 days after colectomy, heart valve repair/replacement, or abdominal aortic aneurysm repair (all P < 0.03). Fewer disparities were observed for Hispanics, than for black patients, and also for cancer, than for noncancer surgical procedures. CONCLUSIONS Important racial/ethnic disparities in perioperative outcomes were observed among patients undergoing major cancer and noncancer surgical procedures at American College of Surgeons National Surgical Quality Improvement Program institutions. There were fewer disparities among individuals undergoing cancer surgery, though black patients, in particular, were more likely to experience prolonged length of stay.
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12
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Mehta RH, Shahian DM, Sheng S, O'Brien SM, Edwards FH, Jacobs JP, Peterson ED. Association of Hospital and Physician Characteristics and Care Processes With Racial Disparities in Procedural Outcomes Among Contemporary Patients Undergoing Coronary Artery Bypass Grafting Surgery. Circulation 2016; 133:124-30. [PMID: 26603032 DOI: 10.1161/circulationaha.115.015957] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have reported that black patients undergoing coronary artery bypass surgery had worse outcomes than white patients, even after accounting for patient factors. The degree to which clinician, hospital, and care factors account for these outcome differences remains unclear. METHODS AND RESULTS We evaluated procedural outcomes in 11,697 blacks and 136,362 whites undergoing isolated coronary artery bypass surgery at 663 Society of Thoracic Surgery Database participating sites (January 1, 2010 to June 30, 2011) adjusted for patients' clinical and socioeconomic features, hospital and surgeon effects, and care processes (internal mammary artery graft and perioperative medications use). Relative to whites, blacks undergoing coronary artery bypass surgery were younger, yet had higher comorbidities and more adverse presenting features. Blacks were also more likely to be treated at hospitals with higher risk-adjusted mortality. The use of internal mammary artery was marginally lower in blacks than in whites (93.3% versus 92.2%, P<0.0001). Unadjusted mortality and major morbidity rates were higher in blacks than in whites (1.8% versus 2.5%, P<0.0001) and (13.6% versus 19.4%, P<0.0001), respectively. These racial differences in outcomes narrowed but still persisted after adjusting for surgeon, hospital, and care processes in addition to patient and socioeconomic factors (odds ratio, 1.17; 95% confidence interval, 1.00-1.36 and odds ratio, 1.26; 95% confidence interval, 1.19-1.34, respectively). CONCLUSIONS The risks of procedural mortality and morbidity after coronary artery bypass surgery were higher among black patients than among white patients. These differences were in part accounted for by patient comorbidities, socioeconomic status, and surgeon, hospital, and care factors, as well, as suggested by the reduction in the strength of the race-outcomes association. However, black race remained an independent predictor of outcomes even after accounting for these differences.
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Affiliation(s)
- Rajendra H Mehta
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.).
| | - David M Shahian
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Shubin Sheng
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Sean M O'Brien
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Fred H Edwards
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Jeffery P Jacobs
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
| | - Eric D Peterson
- From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (R.H.M., S.S., S.M.O'B., E.D.P.); Massachusetts General Hospital, Boston (D.M.S.); The Society of Thoracic Surgeons, Chicago, IL (F.H.E.); and John Hopkins University, Baltimore, MD (J.P.J.)
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13
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Efird JT, O'Neal WT, Davies SW, O'Neal JB, Chitwood WR, Ferguson TB, Kypson AP. Operative status and survival after coronary artery bypass grafting. Heart Surg Forum 2015; 17:E82-90. [PMID: 24808447 DOI: 10.1532/hsf98.2013310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effect of race on long-term survival of patients undergoing elective and nonelective coronary artery bypass grafting (CABG) is currently unknown. The purpose of this study was to compare long-term survival between black and white CABG patients by operative status. METHODS Long-term survival of black versus white patients undergoing elective and nonelective CABG procedures between 1992 and 2011 was compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS A total of 13,774 patients were included in this study. The median follow-up time for study participants was 8.2 years. Black patients undergoing elective CABG died sooner than whites (adjusted HR = 1.4, 95% CI = 1.2-1.5). Survival was similar between blacks and whites in the nonelective population (adjusted HR = 1.0, 95% CI = 0.96-1.1). CONCLUSIONS Black race was a statistically significant predictor of long-term survival after elective but not nonelective CABG.
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Affiliation(s)
- Jimmy T Efird
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Wesley T O'Neal
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Jason B O'Neal
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - W Randolph Chitwood
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - T Bruce Ferguson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - Alan P Kypson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
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Efird JT, O'Neal WT, Griffin WF, Anderson EJ, Davies SW, Landrine H, O'Neal JB, Shiue KY, Kindell LC, Bruce Ferguson T, Randolph Chitwood W, Kypson AP. Increased coronary artery disease severity in black women undergoing coronary bypass surgery. Medicine (Baltimore) 2015; 94:e552. [PMID: 25700324 PMCID: PMC4554167 DOI: 10.1097/md.0000000000000552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Race and sex disparities are believed to play an important role in heart disease. The purpose of this study was to examine the association between race, sex, and number of diseased vessels at the time of coronary artery bypass grafting (CABG), and subsequent postoperative outcomes. The 13,774 patients undergoing first-time, isolated CABG between 1992 and 2011 were included. Trend in the number of diseased vessels between black and white patients, stratified by sex, were analyzed using a Cochran-Armitage trend test. Models were adjusted for age, procedural status (elective vs. nonelective), and payor type (private vs. nonprivate insurance). Black female CABG patients presented with an increasingly greater number of diseased vessels than white female CABG patients (adjusted P(trend) = 0.0021). A similar trend was not observed between black and white male CABG patients (adjusted P(trend) = 0.18). Black female CABG patients were also more likely to have longer intensive care unit and hospital lengths of stay than other race-sex groups.Our findings suggest that black female CABG patients have more advanced coronary artery disease than white female CABG patients. Further research is needed to determine the benefit of targeted preventive care and preoperative workup for this high-risk group.
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Affiliation(s)
- Jimmy T Efird
- From the Department of Cardiovascular Sciences (JTE, WFG, KYS, LCK, TBF, WRC, APK), East Carolina Heart Institute; Center for Health Disparities (JTE, HL), Brody School of Medicine, East Carolina University, Greenville; Department of Internal Medicine (WTO), Wake Forest School of Medicine, Winston-Salem; Department of Pharmacology and Toxicology (EJA), Brody School of Medicine, East Carolina University, Greenville, North Carolina; Department of General Surgery (SWD), University of Virginia School of Medicine, Charlottesville, Virginia; and Department of Anesthesia (JBO), Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Takagi H, Umemoto T. Worse long-term survival after off-pump than on-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014; 148:1820-9. [DOI: 10.1016/j.jtcvs.2014.05.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/06/2014] [Accepted: 05/16/2014] [Indexed: 11/16/2022]
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O'Neal WT, Efird JT, Davies SW, O'Neal JB, Griffin WF, Ferguson TB, Chitwood WR, Kypson AP. Discharge β-Blocker Use and Race after Coronary Artery Bypass Grafting. Front Public Health 2014; 2:94. [PMID: 25121083 PMCID: PMC4114325 DOI: 10.3389/fpubh.2014.00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/09/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The use of discharge β-blockers after cardiac surgery is associated with a long-term mortality benefit. β-Blockers have been suggested to be less effective in black cardiovascular patients compared with whites. To date, racial differences in the long-term survival of coronary artery bypass grafting (CABG) patients who receive β-blockers at discharge have not been examined. METHODS A retrospective cohort study was conducted on patients undergoing CABG between 2002 and 2011. Long-term survival was compared in patients who were and who were not discharged with β-blockers. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. P-for-interaction between race and discharge β-blocker use was computed using a likelihood ratio test. RESULTS A total of 853 (88%) black (n = 970) and 3,038 (88%) white (n = 3,460) patients had a history of β-blocker use at discharge (N = 4,430). Black patients who received β-blockers survived longer than those not receiving β-blockers and the survival advantage was comparable with white patients (black, adjusted HR = 0.33, 95% CI = 0.23-0.46; white, adjusted HR = 0.48, 95% CI = 0.39-0.58; p-for-interaction = 0.74). Among patients discharged on β-blockers, we did not observe a long-term survival advantage for white compared with black patients (HR = 1.2, 95% CI = 0.95-1.5). CONCLUSION β-Blocker use at discharge was associated with a survival advantage among black patients after CABG and a similar association was observed in white patients.
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Affiliation(s)
- Wesley T O'Neal
- Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem, NC , USA
| | - Jimmy T Efird
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University , Greenville, NC , USA ; Center for Health Disparities, Brody School of Medicine, East Carolina University , Greenville, NC , USA
| | - Stephen W Davies
- Department of General Surgery, University of Virginia School of Medicine , Charlottesville, VA , USA
| | - Jason B O'Neal
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - William F Griffin
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University , Greenville, NC , USA
| | - T Bruce Ferguson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University , Greenville, NC , USA
| | - W Randolph Chitwood
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University , Greenville, NC , USA
| | - Alan P Kypson
- East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University , Greenville, NC , USA
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Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care. Ann Surg 2014; 259:1086-90. [PMID: 24441810 DOI: 10.1097/sla.0000000000000326] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. BACKGROUND Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in readmissions after a surgical procedure, an area which is becoming a prime focus for clinical leaders and policymakers. METHODS Using national Medicare data from 2007 to 2010, we examined 30-day readmissions for patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if black patients had higher readmission rates than white patients, and if so, whether this effect was mediated by the hospitals at which patients received care, or by poverty. RESULTS Black patients had higher readmission rates than white patients (14.8% vs 12.8%, odds ratio [OR] 1.19; 95% confidence interval [CI], 1.16-1.22; P < 0.001). Patients undergoing major surgery at minority-serving hospitals also had higher readmission rates (14.3% vs 12.8%, OR 1.14, 95% CI 1.09-1.19; P < 0.001). In multivariate analyses, black patients at minority-serving hospitals had the highest overall odds of readmissions (OR 1.34). White patients at minority-serving hospitals (OR 1.15) and black patients at non-minority-serving hospitals (OR 1.20) also had higher odds of readmission than the reference group of white patients at non-minority-serving hospitals. Racial disparities were mediated in part by poverty. CONCLUSIONS Among Medicare beneficiaries, black patients were more likely to be readmitted after hospitalization for surgical procedures. Since racial disparities in readmission rates are mediated both by patients' race and the hospital at which care is delivered, efforts at reducing disparities should focus not only on race-based measures but also on improving outcomes of care at minority-serving hospitals.
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Efird JT, Davies SW, O'Neal WT, Anderson CA, Anderson EJ, O'Neal JB, Ferguson TB, Chitwood WR, Kypson AP. The impact of race and postoperative atrial fibrillation on operative mortality after elective coronary artery bypass grafting. Eur J Cardiothorac Surg 2013; 45:e20-5. [PMID: 24288342 DOI: 10.1093/ejcts/ezt529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Black patients are less likely to develop postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) than whites. However, the influence of race and POAF on operative mortality has not been examined. The objective of this study was to determine the influence of race and POAF on operative mortality after CABG. METHODS Patients undergoing elective CABG between 1992 and 2011 were included. Operative mortality was compared between patients with and those without new-onset POAF by race. Relative risk (RR) and 95% confidence intervals (CI) were computed using Poisson (robust variance estimates) and log-binomial regression models. RESULTS A total of 1215 (23%) patients developed POAF (white n=1060; black n=155) following CABG (N=5387). Operative mortality differed by POAF status within race category (white POAF: adjusted RR=1.4, 95% CI=0.86-2.2; black POAF: adjusted RR=5.0, 95% CI=1.9-13; Pinteraction=0.0016). Black POAF patients had a 2-fold increased risk of operative death compared with white POAF patients (Padjusted=0.052). CONCLUSION POAF was observed to be a stronger predictor of operative mortality in black compared with white patients undergoing elective CABG.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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O'Neal WT, Efird JT, Davies SW, Choi YM, Anderson CA, Kindell LC, O'Neal JB, Ferguson TB, Chitwood WR, Kypson AP. Preoperative atrial fibrillation and long-term survival after open heart surgery in a rural tertiary heart institute. Heart Lung 2013; 42:442-7. [PMID: 23988129 DOI: 10.1016/j.hrtlng.2013.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Preoperative atrial fibrillation (AF) is associated with increased morbidity and mortality after open heart surgery. However, the impact of preoperative AF on long-term survival after open heart surgery has not been widely examined in rural populations. Patients from rural regions are less likely to receive treatment for cardiac conditions and to have adequate medical insurance coverage. OBJECTIVE To examine the influence of preoperative AF on long-term survival following open heart surgery in rural eastern North Carolina. METHODS Long-term survival was compared in patients with and without preoperative AF after coronary artery bypass grafting (CABG) and CABG plus valve (CABG + V) surgery between 2002 and 2011. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. RESULTS The study population consisted of 5438 patients. A total of 263 (5%) patients had preoperative AF. Preoperative AF was an independent predictor of long-term survival (open heart surgery: adjusted HR = 1.6, 95% CI = 1.3-2.0; CABG: adjusted HR = 1.6, 95% CI = 1.3-2.1; CABG + V: adjusted HR = 1.6, 95% CI = 1.1-2.3). CONCLUSION Preoperative AF is an important predictor of long-term survival after open heart surgery in this rural population.
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Affiliation(s)
- Wesley T O'Neal
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples. Can J Cardiol 2013; 29:1629-36. [PMID: 23988340 DOI: 10.1016/j.cjca.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Canada's Aboriginal people experience a disproportionate burden of comorbid illnesses predisposing them to higher rates of atherosclerotic disease. We set out to investigate secular rates of cardiovascular surgery (CVSx) and postsurgical outcomes in Aboriginals compared with non-Aboriginals. METHODS All patients undergoing CVSx in Manitoba, Canada from 1995-2007 (N =12,170 [Aboriginal, 574, 4.7%; non-Aboriginal, 11,596, 95.3%]) were included in our study cohort. Race was self-identified. Age- and sex-adjusted incidence were determined using 2001 and 2006 census data. Multivariable logistic regression models were constructed to determine the association between race and the outcomes of death, infections, and a composite of adverse events. RESULTS CVSx rates were significantly lower in Aboriginals compared with non-Aboriginals (all CVSx, 63.6 vs 97.7 per 10,000 population; coronary artery bypass grafting only, 46.2 vs 71.9 per 10,000 population, respectively). The lower CVSx rates were most pronounced among Aboriginals residing in urban areas (21.0 vs 78.0 per 10,000). Postoperatively, Aboriginals experienced significantly higher odds of infections (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.13-2.34; P = 0.008), in particular pneumonia (OR, 2.24; 95% CI, 1.58-3.19; P < 0.0001). There was no increase in risk of death after surgery (OR, 1.15; 95% CI, 0.63-2.08; P = 0.6) or the composite outcome (OR, 1.0; 95% CI, 0.66-1.52; P = 1.0) compared with non-Aboriginals. CONCLUSIONS Aboriginal peoples, particularly in the urban setting, are considerably less likely to undergo CVSx. When they do, they have postoperative mortality similar to that of non-Aboriginals. Our findings suggest an urban racial disparity in access to CVSx.
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Risk Factors for Postoperative Respiratory Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting. Anesth Pain Med 2012. [DOI: 10.5812/anesthpain.5228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rajaei S, Dabbagh A. Risk factors for postoperative respiratory mortality and morbidity in patients undergoing coronary artery bypass grafting. Anesth Pain Med 2012; 2:60-5. [PMID: 24223339 PMCID: PMC3821115 DOI: 10.5812/aapm.5228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/18/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Nowadays, coronary artery bypass grafting (CABG) is considered to be one of the most common surgical procedures. This procedure has been the main topic in many clinical research studies, which have assessed the effect of the procedure on patients’ outcomes. Like other surgical procedures, this procedure is also accompanied by a number of unwanted complications, including those of the respiratory system. Since the respiratory system plays an integral role in defining the clinical outcome of patients, improvements in studies that can assess and predict clinical outcomes of the respiratory system, assume greater importance. There are a number of predictive models which can assess patients in the preoperative period and introduce a number of risk factors, which could be considered as prognostic factors for patients undergoing CABG. The respiratory system is among the clinical systems that are assessed in many prediction scoring systems. This review assesses the main studies which have evaluated the possible risk factors for postoperative respiratory mortality and morbidity, in patients undergoing CABG.
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Affiliation(s)
- Samira Rajaei
- Department of lab Sciences, School of Allied Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ali Dabbagh, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2122432572, Fax: +98-2122432572, E-mail:
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Hansen CM, Olesen JB, Hansen ML, Azimi A, Torp-Pedersen C, Dominguez H. Initiation and persistence with warfarin therapy in atrial fibrillation according to ethnicity. Front Pharmacol 2012; 3:123. [PMID: 22754529 PMCID: PMC3385210 DOI: 10.3389/fphar.2012.00123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 06/07/2012] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to investigate initiation of and persistence with warfarin treatment in patients with atrial fibrillation (AF) according to ethnicity. Patients hospitalized with first-time AF from 1997 to 2009, prescription claims of warfarin and country of birth were identified by individual-level linkage of nationwide administrative agencies. Cox proportional hazards models were used to estimate the relationship between covariates affecting initiation and non-persistence with warfarin treatment. A total of 151,537 patients were included in the study and 5,061(3.3%) were of non-Danish origin. CHADS2 score distribution varied substantially according to ethnicity, the proportion of patients with CHADS2 score ≥1 being 79.2, 78.1, 65.9, and 46.0% for patients of Danish, Western, Eastern, and African origin, respectively. 79,239(52.4%) of all patients initiated treatment with warfarin at some point in time. Multivariable Cox proportional hazard analyses indicated patients of Eastern and African origin were less likely to initiate warfarin therapy (HR 0.75; 95% CI 0.69-0.82 and HR 0.58; 95% CI 0.44-0.76, respectively). Patients of Eastern origin were more likely to interrupt treatment (HR 1.23; 95% CI 1.02-1.47; for all patients; HR 1.62; 95% CI 1.22-2.16; for patients with CHADS2 score >1). African origin was associated with a trend to interrupt treatment (HR 1.44; 95% CI 0.46-4.47; for patients with CHADS2 score >1). Initiation of and persistence with warfarin in AF patients is lower among patients of Eastern and African origin compared to patients of Danish and Western origin, despite equal access to health care and medication. Future studies should address, beyond ethnicity, all possible driving factors of (non)initiation and persistence with treatment in general. This will be particularly interesting in light of the new generation of anticoagulants, which might render different adherence to treatment.
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Vassileva CM, Markwell S, Boley T, Hazelrigg S. Impact of race on short-term outcomes of patients undergoing combined coronary artery bypass grafting and mitral valve repair. J Thorac Cardiovasc Surg 2011; 141:845-6. [DOI: 10.1016/j.jtcvs.2010.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 11/22/2010] [Accepted: 12/16/2010] [Indexed: 11/16/2022]
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Dominguez H, Schramm TK, Gislason GH, Norgaard ML, Raunsø J, Abildstrøm SZ, Kober L, Poulsen HE, Torp-Pedersen CT. National Background is Associated with Disparities in Initiation and Persistence to Statin Treatment in Subjects with Diabetes in Denmark. Front Pharmacol 2010; 1:142. [PMID: 21833181 PMCID: PMC3153016 DOI: 10.3389/fphar.2010.00142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/02/2010] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the effects of statin use over the last 10 years among diabetic patients who initiated glucose-lowering medications (GLMs) in Denmark. METHODS we identified all Danish citizens 30 years and older who claimed their first GLM between 1997 and 2006, with follow-up until 2007. Use of medications, national background, income, and hospitalizations were obtained by cross-linkage of national registries in Denmark. We analyzed factors related to initiation and interruption of statin treatment. The analyses included country of birth, citizenship and, as proxy for ethnic origin, we constructed variables based on both the subjects and on their parent's country of birth. Countries were grouped as Denmark, Western countries, Eastern countries, and Africa. RESULTS the cohort included 143,625 subjects. Compared with persons of Danish origin, the initiation of a statin medication during follow-up was significantly lower among patients of non-Danish origin: Odds ratio for subjects of Eastern origin 0.61 [CI 0.49-0.76] and 0.37 for subjects of African origin, [CI 0.24-0.59], both p < 0.001. The risk of interrupting statin treatment once it had been initiated was also higher in these groups (hazard ratio 2.03, [CI 1.91-2.17] for Eastern subjects and 1.94, [CI 1.63-2.32] for African subjects, both p < 0.0001). Combination of ethnic parameters to refine identification of the cohort led to the same conclusions as the analysis based only on country of birth or citizenship respectively. CONCLUSION diabetes patients of African and Eastern origin in Denmark have less chance of being treated with a statin than those of western and Danish origin despite similar access to the Danish health care system.
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Affiliation(s)
- Helena Dominguez
- Department of Cardiology, Herlev Hospital, Copenhagen UniversityHerlev, Denmark
| | - Tina Kenn Schramm
- The Heart Center, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | | | - Mette Lykke Norgaard
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
| | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
| | - Steen Zabell Abildstrøm
- National Institute of Public Health, University of Southern DenmarkCopenhagen, Denmark
- Clinical Pharmacology Q7642, RigshospitaletCopenhagen, Denmark
| | - Lars Kober
- The Heart Center, Rigshospitalet, Copenhagen University HospitalCopenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Clinical Pharmacology Q7642, RigshospitaletCopenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg HospitalCopenhagen, Denmark
- Faculty of Health Sciences, University of CopenhagenDenmark
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital GentofteHellerup, Denmark
- Faculty of Health Sciences, University of CopenhagenDenmark
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