Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization: A United States Experience over the Last Decade

Nileshkumar J. Patel, Sushruth Edla, Abhishek Deshmukh, Nikhil Nalluri, Nilay Patel, Kanishk Agnihotri, Achint Patel, Chirag Savani, Nish Patel, Ronak Bhimani, Badal Thakkar, Shilpkumar Arora, Deepak Asti, Apurva O. Badheka, Valay Parikh, Raul D. Mitrani, Peter Noseworthy, Hakan Paydak, Juan Viles-Gonzalez, Paul Andrew FriedmanMarcin Kowalski

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51%, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95% of the ICDs were implanted in insured patients, and 5% were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist.

Original languageEnglish (US)
Pages (from-to)63-71
Number of pages9
JournalClinical Cardiology
Volume39
Issue number2
DOIs
StatePublished - Feb 1 2016

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Implantable Defibrillators
Health Insurance
Population
Cardiac Resynchronization Therapy
Defibrillators
International Classification of Diseases
Inpatients
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization : A United States Experience over the Last Decade. / Patel, Nileshkumar J.; Edla, Sushruth; Deshmukh, Abhishek; Nalluri, Nikhil; Patel, Nilay; Agnihotri, Kanishk; Patel, Achint; Savani, Chirag; Patel, Nish; Bhimani, Ronak; Thakkar, Badal; Arora, Shilpkumar; Asti, Deepak; Badheka, Apurva O.; Parikh, Valay; Mitrani, Raul D.; Noseworthy, Peter; Paydak, Hakan; Viles-Gonzalez, Juan; Friedman, Paul Andrew; Kowalski, Marcin.

In: Clinical Cardiology, Vol. 39, No. 2, 01.02.2016, p. 63-71.

Research output: Contribution to journalArticle

Patel, NJ, Edla, S, Deshmukh, A, Nalluri, N, Patel, N, Agnihotri, K, Patel, A, Savani, C, Patel, N, Bhimani, R, Thakkar, B, Arora, S, Asti, D, Badheka, AO, Parikh, V, Mitrani, RD, Noseworthy, P, Paydak, H, Viles-Gonzalez, J, Friedman, PA & Kowalski, M 2016, 'Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization: A United States Experience over the Last Decade', Clinical Cardiology, vol. 39, no. 2, pp. 63-71. https://doi.org/10.1002/clc.22496
Patel, Nileshkumar J. ; Edla, Sushruth ; Deshmukh, Abhishek ; Nalluri, Nikhil ; Patel, Nilay ; Agnihotri, Kanishk ; Patel, Achint ; Savani, Chirag ; Patel, Nish ; Bhimani, Ronak ; Thakkar, Badal ; Arora, Shilpkumar ; Asti, Deepak ; Badheka, Apurva O. ; Parikh, Valay ; Mitrani, Raul D. ; Noseworthy, Peter ; Paydak, Hakan ; Viles-Gonzalez, Juan ; Friedman, Paul Andrew ; Kowalski, Marcin. / Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization : A United States Experience over the Last Decade. In: Clinical Cardiology. 2016 ; Vol. 39, No. 2. pp. 63-71.
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abstract = "Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51{\%}, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95{\%} of the ICDs were implanted in insured patients, and 5{\%} were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist.",
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AU - Patel, Nilay

AU - Agnihotri, Kanishk

AU - Patel, Achint

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AU - Patel, Nish

AU - Bhimani, Ronak

AU - Thakkar, Badal

AU - Arora, Shilpkumar

AU - Asti, Deepak

AU - Badheka, Apurva O.

AU - Parikh, Valay

AU - Mitrani, Raul D.

AU - Noseworthy, Peter

AU - Paydak, Hakan

AU - Viles-Gonzalez, Juan

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