People from 'socially vulnerable' counties hospitalized for COVID-19 had more heart problems, 更高的死亡率

Adults from the most socially vulnerable counties in the U.S. 在因COVID-19住院时，比那些来自不太脆弱地区的人更容易死亡或出现严重的心脏问题——即使考虑到潜在条件或COVID-19感染严重程度的差异, 新的研究表明.

来自最脆弱地区的患者也更有可能是黑人，并且不太可能接受潜在有益的COVID-19治疗, 根据这项研究, 周一发表于 Circulation: Cardiovascular Quality and Outcomes.

"Throughout this public health crisis, 在社会经济上处于弱势地位或来自少数种族和族裔背景的个人不成比例地承受了COVID-19的负担,该研究的主要作者Dr. Rishi Wadhera, an assistant professor of medicine at Harvard Medical School in Boston. He is also a cardiologist and section head of health policy and equity at the Richard A. 苏珊·F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center.

“在下一次COVID-19病例激增或下一次公共卫生危机期间，我们需要优先考虑保护患者免受社会弱势社区的侵害，以确保我们实现公平的卫生结果,他说.

Using data from the 美国心脏协会 COVID-19 Cardiovascular Disease Registry, 瓦德拉和他的同事分析了16名患者的住院死亡率和主要心血管线上娱乐电子游戏网站,939 adults with COVID-19 admitted to 107 hospitals across the country between Jan. 11月14日及11月14日. 30, 2020.

登记处的数据与疾病控制和预防中心的社会脆弱性指数的县级数据相关联, which measures the negative impact on communities caused by external stressors on human health. The index is a composite measure of factors that include socioeconomic status, 家庭的组成, 残疾, 少数民族地位和语言, housing type and access to transportation.

研究人员发现，来自社会最脆弱县的人在因COVID-19住院时死亡的可能性比来自最不脆弱县的人高25%, especially during the pandemic's early stages. 来自最脆弱地区的人患严重心脏疾病的可能性也高出26%, including cardiac arrest – when the heart stops suddenly – and acute coronary syndrome, 以心脏供血突然减少为特征的一组状况(包括心脏病发作.

来自社会最脆弱县的COVID-19患者在入院时也更有可能需要呼吸机和其他类型的医疗支持. 然而, 与那些来自社会最不脆弱县的人相比，他们接受关键治疗的可能性更小, 比如类固醇. 他们更有可能被医疗补助覆盖，平均年龄略年轻——60岁对62岁——比那些社会最不脆弱地区的人.

大量研究将与人们居住的社区有关的社会和经济因素与他们的健康质量和获得保健的机会联系起来. 正因为如此, 瓦德拉说，他并不惊讶地发现，来自社会最脆弱地区的人在因COVID-19住院时的情况更糟.

"It did surprise us that despite being sicker when they came to the hospital, these patients were less likely to receive steroid therapy, an important evidence-based treatment for COVID-19,他说.

然而，这项研究并没有探究为什么来自社会脆弱县的患者更有可能死亡, Wadhera cited several factors that could account for the disparities. "Evidence was rapidly changing and evolving over the course of the pandemic. 医学进步可能没有以公平的方式在卫生系统中传播. 另外, 在这场危机中，社会脆弱社区资源较少的医院可能承受了巨大压力, which could also adversely affect outcomes,他说.

新冠肺炎疫情凸显了美国弱势群体面临的日益扩大的社会差距.S.医生说。. Safi Khan, a cardiology fellow at Houston Methodist Hospital who wrote an 编辑 伴随研究而来的. “我们需要努力强调并引发政策变化，以解决这些根深蒂固的社会问题,他说.

全民健康保险可在消除公平保健方面的差距方面发挥重要作用, 他说. “除了, 我们需要把重点放在社区的邮政编码上，那里的居民获得医疗保健的机会有限”和改善健康的机会, 如获得实惠, healthy foods and recreational spaces.

"During a public health crisis of this magnitude, we need to ensure that health systems with fewer resources receive the support they need,瓦德拉说, “我们动用了所有必要的公共卫生和政策杠杆，以保护最脆弱的患者群体和社区."

瓦德拉说，这需要联邦、州和地方各级的干预才能实现.

In addition to a patient's symptoms and diagnosis, 在评估患者的需求时，应考虑到有关多种社会和经济因素的信息, 可汗说:.

他说:“有必要开发一种可以预测健康结果的‘多元社会风险评分’。. "Such tools can be incorporated into practice and allow community-based interventions."

Editor's note: Because of the rapidly evolving events surrounding the coronavirus, the facts and advice presented in this story may have changed since publication. 访问的心.Org获取最新报道, 并向疾病控制和预防中心以及当地卫生官员咨询最新的指导意见.

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