BACKGROUND:Short-term race- and sex-specific case- fatality rates for pulmonary embolism (PE) in the elderly have not been studied previously, to our knowledge.

OBJECTIVES:To examine 30-day race- and sex-specific case-fatality rates of PE in the Medicare population and to determine the risk of fatality when PE was a secondary diagnosis in 6 primary concurrent conditions and 3 surgical procedures.

METHODS:Case-fatality rates were determined using the Medicare Provider Analysis and Review Record tiles from 1984 through 1991. All Medicare Part A beneficiaries aged 65 years or older were included, yielding more than 400,000 patients with PE. Case-fatality rates 30 days from hospital admission were calculated for both a primary discharge diagnosis of PE and a secondary discharge diagnosis of PE.

RESULTS:Blacks with PE as a primary discharge diagnosis had an overall age-adjusted case-fatality rate of 16.1% compared with a rate of 12.9% for whites. When PE was a secondary diagnosis, blacks also had higher rates than whites (34.7% vs 30.2%). Men had a fatality rate of 13.7% whereas women had a rate of 12.8% when PE was the primary diagnosis. For a secondary diagnosis of PE, men had a rate of 32.8% compared with a rate of 28.6% for women. The risk of fatality was very high when PE was a secondary discharge diagnosis in 6 primary concurrent conditions (congestive heart failure, cancer, chronic obstructive pulmonary disease, myocardial infarction, hip fracture, and stroke) and 3 common surgical procedures (coronary artery bypass graft, hip replacement, and knee replacement) relative to the case-fatality rate when PE was not present in these conditions.

CONCLUSIONS:Our results indicate that there are racial and gender differences in 30-day case-fatality rates for PE in elderly patients. The high fatality risk associated with PE as a comorbid factor among common primary concurrent conditions and procedures calls attention to the need for more effective prophylaxis of deep vein thrombosis and rapid diagnosis and treatment of PE when it occurs.

译文

背景:据我们所知,以前尚未研究老年人的短期种族和性别特定病例的肺栓塞(PE)死亡率。

目的:研究在6种主要并发疾病和3种手术方法中对PE进行二次诊断时,在Medicare人群中PE的30天种族和性别特定病死率,并确定死亡风险。

方法:使用1984年至1991年的Medicare Provider Analysis and Review Record磁贴确定了病死率。其中包括所有65岁或65岁以上的Medicare A部分受益人。超过40万名PE患者。计算住院后30天的PE初次出院诊断和PE初次出院诊断的病死率。

结果:以PE作为初次出院诊断的黑人年龄调整后的总病死率为16.1%,而白人为12.9%。当PE是继发诊断时,黑人的患病率也高于白人(34.7%对30.2%)。当以PE为主要诊断手段时,男性的死亡率为13.7%,而女性的死亡率为12.8%。对于PE的继发诊断,男性的比率为32.8%,而女性的比率为28.6%。当PE在6种主要的并发情况(充血性心力衰竭,癌症,慢性阻塞性肺疾病,心肌梗塞,髋部骨折和中风)和3种常见外科手术方法(冠状动脉搭桥术)中进行二次出院诊断时,死亡的风险非常高,髋关节置换术和膝关节置换术)相对于在这种情况下不存在PE时的病死率。

结论:我们的结果表明,老年患者PE的30天病死率。在常见的主要并发疾病和手术过程中,与PE作为合并症的高致死风险一起引起人们的注意,即需要更有效地预防深静脉血栓形成,并在发生PE时迅速进行诊断和治疗。

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