TY - JOUR
T1 - Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement
T2 - Insights from the Healthcare Cost and Utilization Project's National Inpatient Sample
AU - Hernandez-Suarez, Dagmar F.
AU - Ranka, Sagar
AU - Villablanca, Pedro
AU - Yordan-Lopez, Nicole
AU - González-Sepúlveda, Lorena
AU - Wiley, Jose
AU - Sanina, Cristina
AU - Roche-Lima, Abiel
AU - Nieves-Rodriguez, Brenda G.
AU - Thomas, Stacey
AU - Cox-Alomar, Pedro
AU - Lopez-Candales, Angel
AU - Ramakrishna, Harish
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/7
Y1 - 2019/7
N2 - Purpose: To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US). Methods and results: The National Inpatient Sample database was queried for patients ≥18 years of age who underwent TAVR from 2012 to 2014. The primary outcome was all-cause in hospital mortality. A total of 36,270 individuals were included in the study. The number of TAVR performed per million population increased in all study groups over the three years [38.8 to 103.8 (NHW); 9.1 to 26.4 (AA) and 9.4 to 18.2 (Hispanics)]. The overall in-hospital mortality was 4.2% for the entire cohort. Race/ethnicity showed no association with in-hospital mortality (P >.05). Though no significant difference were found between AA and NHW in any secondary outcome, being Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95% CI, 1.06–3.85; P =.03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04–3.14; P =.04), acute kidney injury (aOR = 1.65; 95% CI, 1.23–2.21; P <.01), prolonged length of stay (aOR = 1.18; 95% CI, 1.08–1.29; P <.01) and higher hospital costs (aOR = 1.27; 95% CI, 1.18–1.36; P <.01). Conclusion: There are significant racial disparities in patients undergoing TAVR in the US. Though in-hospital mortality was not associated with race/ethnicity, Hispanic patients had less TAVR utilization, higher in-hospital complications, prolonged length of stay and increased hospital costs.
AB - Purpose: To identify racial/ethnic disparities in utilization rates, in-hospital outcomes and health care resource use among Non-Hispanic Whites (NHW), African Americans (AA) and Hispanics undergoing transcatheter aortic valve replacement (TAVR) in the United States (US). Methods and results: The National Inpatient Sample database was queried for patients ≥18 years of age who underwent TAVR from 2012 to 2014. The primary outcome was all-cause in hospital mortality. A total of 36,270 individuals were included in the study. The number of TAVR performed per million population increased in all study groups over the three years [38.8 to 103.8 (NHW); 9.1 to 26.4 (AA) and 9.4 to 18.2 (Hispanics)]. The overall in-hospital mortality was 4.2% for the entire cohort. Race/ethnicity showed no association with in-hospital mortality (P >.05). Though no significant difference were found between AA and NHW in any secondary outcome, being Hispanic was associated with higher incidence of acute myocardial infarction (aOR = 2.02; 95% CI, 1.06–3.85; P =.03), stroke/transient ischemic attack (aOR = 1.81; 95% CI, 1.04–3.14; P =.04), acute kidney injury (aOR = 1.65; 95% CI, 1.23–2.21; P <.01), prolonged length of stay (aOR = 1.18; 95% CI, 1.08–1.29; P <.01) and higher hospital costs (aOR = 1.27; 95% CI, 1.18–1.36; P <.01). Conclusion: There are significant racial disparities in patients undergoing TAVR in the US. Though in-hospital mortality was not associated with race/ethnicity, Hispanic patients had less TAVR utilization, higher in-hospital complications, prolonged length of stay and increased hospital costs.
KW - Comparative outcomes
KW - Disparity
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.carrev.2019.04.005
DO - 10.1016/j.carrev.2019.04.005
M3 - Article
C2 - 30987828
AN - SCOPUS:85064160837
SN - 1553-8389
VL - 20
SP - 546
EP - 552
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 7
ER -