Racial/ethnic disparities in patients undergoing transcatheter aortic valve replacement

Insights from the healthcare cost and utilization project's national inpatient sample

Dagmar F. Hernandez-Suarez, Sagar Ranka, Pedro Villablanca, Nicole Yordan-Lopez, Lorena González-Sepúlveda, Jose M. Wiley, Cristina Sanina, Abiel Roche-Lima, Brenda G. Nieves-Rodriguez, Stacey Thomas, Pedro Cox-Alomar, Angel Lopez-Candales, Harish Ramakrishna

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Health Care Costs
Inpatients
Hospital Mortality
Hispanic Americans
African Americans
Hospital Costs
Length of Stay
Health Resources
Transient Ischemic Attack
Acute Kidney Injury
Stroke
Myocardial Infarction
Transcatheter Aortic Valve Replacement
Databases
Delivery of Health Care
Incidence
Population

Keywords

  • Comparative outcomes
  • Disparity
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Racial/ethnic disparities in patients undergoing transcatheter aortic valve replacement : Insights from the healthcare cost and utilization project's national inpatient sample. / Hernandez-Suarez, Dagmar F.; Ranka, Sagar; Villablanca, Pedro; Yordan-Lopez, Nicole; González-Sepúlveda, Lorena; Wiley, Jose M.; Sanina, Cristina; Roche-Lima, Abiel; Nieves-Rodriguez, Brenda G.; Thomas, Stacey; Cox-Alomar, Pedro; Lopez-Candales, Angel; Ramakrishna, Harish.

In: Cardiovascular Revascularization Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Hernandez-Suarez, DF, Ranka, S, Villablanca, P, Yordan-Lopez, N, González-Sepúlveda, L, Wiley, JM, Sanina, C, Roche-Lima, A, Nieves-Rodriguez, BG, Thomas, S, Cox-Alomar, P, Lopez-Candales, A & Ramakrishna, H 2019, 'Racial/ethnic disparities in patients undergoing transcatheter aortic valve replacement: Insights from the healthcare cost and utilization project's national inpatient sample', Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2019.04.005
Hernandez-Suarez, Dagmar F. ; Ranka, Sagar ; Villablanca, Pedro ; Yordan-Lopez, Nicole ; González-Sepúlveda, Lorena ; Wiley, Jose M. ; Sanina, Cristina ; Roche-Lima, Abiel ; Nieves-Rodriguez, Brenda G. ; Thomas, Stacey ; Cox-Alomar, Pedro ; Lopez-Candales, Angel ; Ramakrishna, Harish. / Racial/ethnic disparities in patients undergoing transcatheter aortic valve replacement : Insights from the healthcare cost and utilization project's national inpatient sample. In: Cardiovascular Revascularization Medicine. 2019.
@article{2e3ee4e0ab25449e981ed545f816e798,
title = "Racial/ethnic disparities in patients undergoing transcatheter aortic valve replacement: Insights from the healthcare cost and utilization project's national inpatient sample",
abstract = "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.",
keywords = "Comparative outcomes, Disparity, Transcatheter aortic valve replacement",
author = "Hernandez-Suarez, {Dagmar F.} and Sagar Ranka and Pedro Villablanca and Nicole Yordan-Lopez and Lorena Gonz{\'a}lez-Sep{\'u}lveda and Wiley, {Jose M.} and Cristina Sanina and Abiel Roche-Lima and Nieves-Rodriguez, {Brenda G.} and Stacey Thomas and Pedro Cox-Alomar and Angel Lopez-Candales and Harish Ramakrishna",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.carrev.2019.04.005",
language = "English (US)",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier Inc.",

}

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 M.

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

PY - 2019/1/1

Y1 - 2019/1/1

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

UR - http://www.scopus.com/inward/record.url?scp=85064160837&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064160837&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2019.04.005

DO - 10.1016/j.carrev.2019.04.005

M3 - Article

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

ER -