未经评估:怀疑心脏移植(HT)结局的种族差异,但不确定。在美国(US),捐助者分配的最近变化对HT差异的额外影响尚不清楚。我们假设HT中存在种族差异,并且可能会因新的分配实践而恶化。
未经评估:队列:心脏分配政策变更前后为HT列出的成年人(时代1:10月18日,2015-10月18日,2018,时代2:10月18日,2018-2021年6月30日)。主要结果是按种族划分的HT率(Blackvs.白色),使用多变量竞争风险分析进行评估(竞争:死亡或临床恶化的候补名单移除)。最终调整后的模型包括合并症,SES和社区层面的健康社会决定因素。次要结果是死亡或临床恶化的候补名单删除。
UASSIGNED:17,384名候补候选人(时代1:9,150,时代2:8,234),在第1时代(调整后的HR0·90,95%CI0·84-0·97,p=0·0053)和第2时代(调整后的HR0·81,95%CI0·75-0·88,p<0·0001,时代种族互动p=0·056),黑人候补候选人的HT率低于白人候补候选人。在第1时代的种族之间,因死亡或恶化而删除候补名单的比率相似(调整后的HR0·92,95%0·77-1·1,p=0·38),但对于第2时代的黑人候选人增加(调整后的HR1·34,95%CI1·09-1·65,p=0·0054,时代种族互动p=0·0051)。
UNASSIGNED:在新的分配制度下,与白人候补候选人相比,黑人的测量移植率和死亡或临床恶化的除名率都有所恶化。这些差异的原因需要进一步研究。
UNASSIGNED:明尼苏达大学心内科基金。
UNASSIGNED: Racial disparities in heart transplantation (HT) outcomes are suspected but uncertain. The additional impact of a recent change in donor allocation on disparities in HT in the United States (US) is unknown. We hypothesize racial disparities in HT are present and may be worsened by new allocation practices.
UNASSIGNED: Cohort: Adults listed for HT before and after a heart allocation policy change (Era 1: Oct 18th, 2015 - Oct 18th, 2018, Era 2: Oct 18th, 2018-June 30, 2021). The primary outcome was the rate of HT by race (Black vs. White), assessed using multivariable competing risk analysis (compete: waitlist removal for death or clinical deterioration). Final adjusted models included co-morbidities, SES and community-level Social Determinants of Health. The secondary outcome was waitlist removal for death or clinical deterioration.
UNASSIGNED: Of 17,384 waitlist candidates (Era 1: 9,150, Era 2: 8,234), Black waitlist candidates had a lower rate of HT compared to White waitlist candidates in Era 1 (adjusted HR 0·90, 95 % CI 0·84-0·97, p = 0·0053) and in Era 2 (adjusted HR 0·81, 95 % CI 0·75-0·88, p <0·0001, era race interaction p=0·056). The rate of waitlist removal for death or deterioration was similar between races in Era 1 (adjusted HR 0·92, 95 % 0·77-1·1, p = 0·38), but increased for Black candidates in Era 2 (adjusted HR 1·34, 95 % CI 1·09-1·65, p = 0·0054, era race interaction p = 0·0051).
UNASSIGNED: Both the measured rate of transplantation and rate of delisting for death or clinical deterioration have worsened for Black compared to White waitlist candidates under the new allocation system. Causes for these disparities require further study.
UNASSIGNED: University of Minnesota Department of Cardiology funds.