Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Authors

Anna Sleder, Henry Ford Health
Shiloh Tackett, Henry Ford Health
Matthew Cerasale, Henry Ford Health
Chetan Mittal, Henry Ford Health
Iyad Isseh, Henry Ford HealthFollow
Ryhm Radjef, Henry Ford HealthFollow
Andrew Taylor, Henry Ford Health
Rashad Farha, Henry Ford Health
Oleksandra Lupak, Henry Ford HealthFollow
Dana Larkin, Henry Ford HealthFollow
Lois Lamerato, Henry Ford HealthFollow
George Divine, Henry Ford HealthFollow
Kimberlydawn Wisdom, Henry Ford HealthFollow
Kimberly Baker-Genaw, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow

Recommended Citation

Sleder A, Tackett S, Cerasale M, Mittal C, Isseh I, Radjef R, Taylor A, Farha R, Lupak O, Larkin D, Lamerato L, Divine G, Wisdom K, Baker-Genaw K, O'Neill W. Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis. J Racial Ethn Health Disparities. 2017 Dec;4(6):1189-1194.

Document Type

Article

Publication Date

12-1-2017

Publication Title

J Racial Ethn Health Disparities

Abstract

BACKGROUND: We sought to quantify socioeconomic disparities in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) at an urban, tertiary referral center.

METHODS: This retrospective case-control study identified 67 patients with severe AS (aortic valve [AV] area ≤1 cm

RESULTS: Income disparity was significant in that with every $10,000 increase in income, the odds of receiving TAVR increased by 10% (p = 0.05). Non-blacks were significantly more likely to receive TAVR than blacks (odds ratio [OR] 2.812, confidence interval [CI] 1.007-7.853; p = 0.048). No differences in comorbidities were found between the two groups. Post hoc analysis to identify etiologies of the found disparities examined differences of AV area and AV area index, indication for two-dimensional echocardiography (echo), symptoms prior to echo, and action after echo within the control group. Black race significantly impacted the TAVR status despite the same AV area (OR 0.33, CI 0.09-0.97, p = 0.043). After echo, blacks were more likely to decline AVR, be lost to follow-up, and not be referred to cardiology (OR 4.41, CI 1.43-13.64; p = 0.010).

CONCLUSION: Socioeconomic and racial disparities were associated with patients with severe AS receiving TAVR at a major referral center. This study emphasizes the importance of improving access to standard of care for these subgroups of cardiac patients.

Medical Subject Headings

African Americans; Aortic Valve Stenosis; Case-Control Studies; Female; Healthcare Disparities; Hospitals, Urban; Humans; Male; Retrospective Studies; Severity of Illness Index; Socioeconomic Factors; Tertiary Care Centers; Transcatheter Aortic Valve Replacement; Treatment Outcome; United States

PubMed ID

28039604

Volume

4

Issue

6

First Page

1189

Last Page

1194