Ethnic disparity in Israel impacts long-term results after heart transplantation
| Autor: | Arwa Younis, Jacob Lavee, Eugenia Raichlin, Ron Loewenthal, Yigal Kassif, Anan Younis, Yael Peled, Eyal Nachum, Dov Freimark |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Multivariate analysis
Cardiovascular mortality Population Ethnic group Ethnic origin White People 03 medical and health sciences 0302 clinical medicine Ethnicity Medicine Humans 030212 general & internal medicine Original Research Article Israel education Survival analysis lcsh:R5-920 education.field_of_study business.industry lcsh:Public aspects of medicine 030503 health policy & services Health Policy Confounding Public Health Environmental and Occupational Health lcsh:RA1-1270 Cardiac allograft vasculopathy Arabs Jews Propensity score matching Population study Heart Transplantation lcsh:Medicine (General) 0305 other medical science business Demography |
| Zdroj: | Israel Journal of Health Policy Research Israel Journal of Health Policy Research, Vol 8, Iss 1, Pp 1-10 (2019) |
| ISSN: | 2045-4015 |
| Popis: | Background Ethnicity may affect graft longevity and recipient mortality after heart transplantation (HTx). We hypothesized that differences in ethnic origin between Arabs and Jews undergoing HTx in Israel may contribute to differences in long-term outcomes. Methods The study population comprised all 254 patients who underwent HTx between 1991 and 2017 in a tertiary medical center located in the center of Israel. Patients were categorized as either Jews (226 patients, 89%) or Arabs (28 patients, 11%). The primary end point was cardiac allograft vasculopathy (CAV), secondary end points were cardiovascular (CV) mortality and the combined end point of CAV/CV mortality. Results In comparison with Jews, Arab patients were significantly younger (ave. age 42 vs. 50) and had shorter in-hospital stay (45 vs. 80 days). However, Kaplan-Meier survival analysis showed that at 10 years of follow-up CAV rates were significantly higher among Arabs (58%) compared with Jews (23%; log-rank P = 0.01) for the overall difference during follow-up. Similar results were shown for the separate end point of CV mortality and the combined end point of CAV/CV mortality. Multivariate analysis, which controlled for age, gender, statin treatment, and other potential confounders, showed that Arab recipient ethnic origin was associated with a significant > 2.5-fold (p = 0.01) increase in the risk for CAV; a > 4-fold increase in the risk for CV mortality (p = 0.001); and approximately 4-fold increase in the risk for the combined end point (p = 0.001). These findings were validated by propensity score analysis. Conclusions Our data suggest that Arab ethnic origin is associated with a significantly increased risk for CAV and mortality following HTx. Suggested explanations contributing to ethnic disparities in Israel include socioeconomic, environmental and genetic factors. Further studies are required to evaluate whether more aggressive risk factor management in the Israeli Arab population following HTx would reduce CAV and CV mortality in this high-risk population. Increased awareness and early intervention of the Israeli healthcare system and cooperation with the Arab community is of paramount importance. |
| Databáze: | OpenAIRE |
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