Implementation of Intravascular Coronary Lithotripsy in the United States: Social Determinants of Health
Recommended Citation
Bahar AR, Bahar Y, Rabib A, Manasrah N, Onal F, Bolaji O, Abidov A, and Alraies MC. Implementation of Intravascular Coronary Lithotripsy in the United States: Social Determinants of Health. JACC Adv 2025;4(10 Pt 2):102099.
Document Type
Article
Publication Date
9-1-2025
Publication Title
JACC Adv
Abstract
BACKGROUND: Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.
OBJECTIVES: This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.
METHODS: Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with P < 0.05 considered significant.
RESULTS: Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; P < 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; P = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; P < 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; P < 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; P = 0.022).
CONCLUSIONS: Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation.
PubMed ID
40897137
Volume
4
Issue
10 Pt 2
First Page
102099
Last Page
102099
