目标:虽然癫痫治疗中存在差异,它们对癫痫持续状态(SE)和相关结局的影响仍未得到充分研究.
方法:我们使用2010-2019年全国住院患者样本,使用国际疾病分类来识别SE住院情况,第九次修订,临床修改(ICD-9-CM)/ICD-10-CM代码。SE患病率按人口统计学分层。Logistic回归用于评估与脑电图(EEG)监测相关的因素,插管,气管造口术,胃造口术,和死亡率。
结果:有486861例SE住院(2010-2019),主要在城市教学医院(71.3%)。非西班牙裔(NH)黑人每10000例住院的SE患病率为27.3,16.1对于NH-其他人,15.8对于西班牙裔,NH-Whites为13.7(p<0.01)。与收入最高的四分位数(18.7vs.14,p<0.01)。年龄较大与插管有关,气管造口术,胃造口术,和住院死亡率。那些≥80岁的人插管的几率最高(优势比[OR]=1.5,95%置信区间[CI]=1.43-1.58),气管造口术(OR=2,95%CI=1.75-2.27),胃造口术(OR=3.37,95%CI=2.97-3.83),和住院死亡率(OR=6.51,95%CI=5.95-7.13)。少数民族人口(NH-Black,NH-Other,和西班牙裔)与NH-白人人群相比,气管造口术和胃造口术的几率更高。NH-Black患者气管造口术(OR=1.7,95%CI=1.57-1.86)和胃造口术(OR=1.78,95%CI=1.65-1.92)的几率最高。随着收入四分位数的增加,接受脑电图监测的几率逐渐增加(OR=1.47,最高收入四分位数的95%CI=1.34-1.62),与农村医院相比,城市教学人员接受脑电图监测的几率更高(OR=12.72,95%CI=8.92-18.14)。NH-Blacks的死亡率较低(与NH-Whites相比)(OR=.71,95%CI=.67-.75),西班牙裔(OR=.82,95%CI=.76-.89),和收入最高的四分位数(OR=.9,95%CI=.84-.97)。
结论:SE患病率存在差异,气管造口术,和胃造瘘术在不同年龄的利用,种族/民族,和收入。年龄大和收入低也与死亡率相关。脑电图监测的访问受收入和城市教学医院状态的调节。老年人,种族/族裔少数,低收入或农村地区的人口可能代表弱势群体,值得更多关注改善健康结果和缩小差距。
OBJECTIVE: Although disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied.
METHODS: We used the 2010-2019 National Inpatient Sample to identify SE hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM codes. SE prevalence was stratified by demographics. Logistic regression was used to assess factors associated with electroencephalographic (EEG) monitoring, intubation, tracheostomy,
gastrostomy, and mortality.
RESULTS: There were 486 861 SE hospitalizations (2010-2019), primarily at urban teaching hospitals (71.3%). SE prevalence per 10 000 admissions was 27.3 for non-Hispanic (NH)-Blacks, 16.1 for NH-Others, 15.8 for Hispanics, and 13.7 for NH-Whites (p < .01). SE prevalence was higher in the lowest (18.7) compared to highest income quartile (18.7 vs. 14, p < .01). Older age was associated with intubation, tracheostomy,
gastrostomy, and in-hospital mortality. Those ≥80 years old had the highest odds of intubation (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.43-1.58), tracheostomy (OR = 2, 95% CI = 1.75-2.27), gastrostomy (OR = 3.37, 95% CI = 2.97-3.83), and in-hospital mortality (OR = 6.51, 95% CI = 5.95-7.13). Minority populations (NH-Black, NH-Other, and Hispanic) had higher odds of tracheostomy and
gastrostomy compared to NH-White populations. NH-Black people had the highest odds of tracheostomy (OR = 1.7, 95% CI = 1.57-1.86) and
gastrostomy (OR = 1.78, 95% CI = 1.65-1.92). The odds of receiving EEG monitoring rose progressively with higher income quartile (OR = 1.47, 95% CI = 1.34-1.62 for the highest income quartile) and was higher for those in urban teaching compared to rural hospitals (OR = 12.72, 95% CI = 8.92-18.14). Odds of mortality were lower (compared to NH-Whites) in NH-Blacks (OR = .71, 95% CI = .67-.75), Hispanics (OR = .82, 95% CI = .76-.89), and those in the highest income quartiles (OR = .9, 95% CI = .84-.97).
CONCLUSIONS: Disparities exist in SE prevalence, tracheostomy, and
gastrostomy utilization across age, race/ethnicity, and income. Older age and lower income are also associated with mortality. Access to EEG monitoring is modulated by income and urban teaching hospital status. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention to improve health outcomes and reduce disparities.