目的:社会经济差异对二尖瓣修复后生存的影响尚不明确。我们研究了患有退行性二尖瓣返流的Medicare受益人的社会经济劣势与中期修复结果之间的关系。
方法:美国医疗保险和医疗补助中心的数据被用来确定在2012年至2019年期间接受孤立性首次修复的10,322名患者。邮政编码级别的社会经济劣势与包含教育水平的贫困社区指数(DCI)区分开来,贫穷,失业,住房保障,中位数收入,和业务增长;DCI评分>80的人被归类为不良。主要结果是生存,3年审查。次要结局包括心力衰竭再入院的累积发生率,二尖瓣再介入,和中风。
结果:在10,322例接受退行性二尖瓣修复的患者中,9.7%(n=1003)来自贫困社区。来自困境社区的患者在低容量中心接受了手术(11vs.16例/年),并进一步进行手术护理(40vs.17英里)(均p<0.001)。三年后,未调整生存率(85.4%,95%CI:82.9-87.5%与89.7%,95%CI:89.0-90.4%)和心力衰竭再入院的累积发生率(11.5%,95%CI:9.6-13.7%与7.4%,95%CI:6.9-8.0%)在来自痛苦社区的患者中更差(所有p<0.001),而二尖瓣再介入率相似(2.7%,95%CI:1.8-4.0%与2.8%,95%CI:2.5-3.2%,p=0.75)。调整后,社区痛苦与3年死亡率(HR:1.21,95%CI:1.01-1.46)和心力衰竭再入院(HR:1.28,95%CI:1.04-1.58)独立相关.
结论:社区水平的社会经济困境与医疗保险受益人中退化性二尖瓣修复的不良结果相关。
OBJECTIVE: The influence of socioeconomic disparities on survival after mitral repair is poorly defined. We examined the association between socioeconomic disadvantage and midterm outcomes of repair in Medicare beneficiaries with degenerative mitral regurgitation.
METHODS: US Centers for Medicare and Medicaid Services data were used to identify 10,322 patients undergoing isolated first-time repair for degenerative mitral regurgitation between 2012 and 2019. Zip code-level socioeconomic disadvantage was dichotomized with the Distressed Communities Index, which incorporates education level, poverty, unemployment, housing security, median income, and business growth; those with Distressed Communities Index score ≥80 were classified as distressed. The primary outcome was survival, censored at 3 years. Secondary outcomes included cumulative incidences of heart failure readmission, mitral reintervention, and stroke.
RESULTS: Of the 10,322 patients undergoing degenerative mitral repair, 9.7% (n = 1003) came from distressed communities. Patients from distressed communities underwent surgery at lower volume centers (11 vs 16 cases/year) and traveled further for surgical care (40 vs 17 miles) (both P values < .001). At 3 years, unadjusted survival (85.4%; 95% CI, 82.9%-87.5% vs 89.7%; 95% CI, 89.0%-90.4%) and cumulative incidence of heart failure readmission (11.5%; 95% CI, 9.6%-13.7% vs 7.4%; 95% CI, 6.9%-8.0%) were worse in patients from distressed communities (all P values < .001), whereas mitral reintervention rates were similar (2.7%; 95% CI, 1.8%-4.0% vs 2.8%; 95% CI, 2.5%-3.2%; P = .75). After adjustment, community distress was independently associated with 3-year mortality (hazard ratio, 1.21; 95% CI, 1.01-1.46) and heart failure readmissions (hazard ratio, 1.28; 95% CI, 1.04-1.58).
CONCLUSIONS: Community-level socioeconomic distress is associated with worse outcomes in degenerative mitral repair among Medicare beneficiaries.