Cargando…

Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?

OBJECTIVE: In this study we sought to evaluate whether disparate use of transcatheter aortic valve replacement (TAVR) among non-White patients has decreased over time, and if unequal access to TAVR is driven by unequal access to high-volume hospitals. METHODS: From 2013 to 2017, we used the State In...

Descripción completa

Detalles Bibliográficos
Autores principales: Cohen, Brian D., Aminpour, Nathan, Wang, Haijun, Sellke, Frank W., Al-Refaie, Waddah B., Ehsan, Afshin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801242/
https://www.ncbi.nlm.nih.gov/pubmed/36590742
http://dx.doi.org/10.1016/j.xjon.2022.07.009
_version_ 1784861460792344576
author Cohen, Brian D.
Aminpour, Nathan
Wang, Haijun
Sellke, Frank W.
Al-Refaie, Waddah B.
Ehsan, Afshin
author_facet Cohen, Brian D.
Aminpour, Nathan
Wang, Haijun
Sellke, Frank W.
Al-Refaie, Waddah B.
Ehsan, Afshin
author_sort Cohen, Brian D.
collection PubMed
description OBJECTIVE: In this study we sought to evaluate whether disparate use of transcatheter aortic valve replacement (TAVR) among non-White patients has decreased over time, and if unequal access to TAVR is driven by unequal access to high-volume hospitals. METHODS: From 2013 to 2017, we used the State Inpatient Database across 8 states (Ariz, Colo, Fla, Md, NC, NM, Nev, Wash) to identify 51,232 Medicare beneficiaries who underwent TAVR versus surgical aortic valve replacement. Hospitals were categorized as low- (<50 per year), medium- (50-100 per year), or high-volume (>100 per year) according to total valve procedures (TAVR + surgical aortic valve replacement). Multivariable logistic regression models with interactions were performed to determine the effect of race, time, and hospital volume on the utilization of TAVR. RESULTS: Non-White patients were less likely to receive TAVR than White patients (odds ratio [OR], 0.77; 95% CI, 0.71-0.83). However, utilization of TAVR increased over time (OR, 1.73; 95% CI, 1.73-1.80) for the total population, with non-White patients’ TAVR use growing faster than for White patients (OR, 1.06; 95% CI, 1.00-1.12), time × race interaction, P = .034. Further, an adjusted volume-stratified time trend analysis showed that utilization of TAVR at high volume hospitals increased faster for non-White patients versus White patients by 8.6% per year (OR, 1.09; 95% CI, 1.01-1.16) whereas use at low- and medium-volume hospitals did not contribute to any decreasing utilization gap. CONCLUSIONS: This analysis shows initial low rates of TAVR utilization among non-White patients followed by accelerated use over time, relative to White patients. This narrowing gap was driven by increased TAVR utilization by non-White patients at high-volume hospitals.
format Online
Article
Text
id pubmed-9801242
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-98012422022-12-31 Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time? Cohen, Brian D. Aminpour, Nathan Wang, Haijun Sellke, Frank W. Al-Refaie, Waddah B. Ehsan, Afshin JTCVS Open Adult: Aortic Valve OBJECTIVE: In this study we sought to evaluate whether disparate use of transcatheter aortic valve replacement (TAVR) among non-White patients has decreased over time, and if unequal access to TAVR is driven by unequal access to high-volume hospitals. METHODS: From 2013 to 2017, we used the State Inpatient Database across 8 states (Ariz, Colo, Fla, Md, NC, NM, Nev, Wash) to identify 51,232 Medicare beneficiaries who underwent TAVR versus surgical aortic valve replacement. Hospitals were categorized as low- (<50 per year), medium- (50-100 per year), or high-volume (>100 per year) according to total valve procedures (TAVR + surgical aortic valve replacement). Multivariable logistic regression models with interactions were performed to determine the effect of race, time, and hospital volume on the utilization of TAVR. RESULTS: Non-White patients were less likely to receive TAVR than White patients (odds ratio [OR], 0.77; 95% CI, 0.71-0.83). However, utilization of TAVR increased over time (OR, 1.73; 95% CI, 1.73-1.80) for the total population, with non-White patients’ TAVR use growing faster than for White patients (OR, 1.06; 95% CI, 1.00-1.12), time × race interaction, P = .034. Further, an adjusted volume-stratified time trend analysis showed that utilization of TAVR at high volume hospitals increased faster for non-White patients versus White patients by 8.6% per year (OR, 1.09; 95% CI, 1.01-1.16) whereas use at low- and medium-volume hospitals did not contribute to any decreasing utilization gap. CONCLUSIONS: This analysis shows initial low rates of TAVR utilization among non-White patients followed by accelerated use over time, relative to White patients. This narrowing gap was driven by increased TAVR utilization by non-White patients at high-volume hospitals. Elsevier 2022-08-05 /pmc/articles/PMC9801242/ /pubmed/36590742 http://dx.doi.org/10.1016/j.xjon.2022.07.009 Text en © 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Adult: Aortic Valve
Cohen, Brian D.
Aminpour, Nathan
Wang, Haijun
Sellke, Frank W.
Al-Refaie, Waddah B.
Ehsan, Afshin
Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title_full Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title_fullStr Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title_full_unstemmed Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title_short Did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
title_sort did ethno-racial disparities in access to transcatheter aortic valve replacement change over time?
topic Adult: Aortic Valve
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801242/
https://www.ncbi.nlm.nih.gov/pubmed/36590742
http://dx.doi.org/10.1016/j.xjon.2022.07.009
work_keys_str_mv AT cohenbriand didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime
AT aminpournathan didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime
AT wanghaijun didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime
AT sellkefrankw didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime
AT alrefaiewaddahb didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime
AT ehsanafshin didethnoracialdisparitiesinaccesstotranscatheteraorticvalvereplacementchangeovertime