Residential Racial Segregation in Aortic Stenosis Diagnosis and Transcatheter Aortic Valve Implantation Among Medicare Patients.

Autor:	Sevilla-Cazes J; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Almarzooq ZI; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kyalwazi AN; Harvard Medical School, Boston, Massachusetts, USA., Wang Y; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Boston Deep Data, Boston, Massachusetts, USA., Song Y; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Batchelor WB; Inova Heart and Vascular Institute, Falls Church, Virginia, USA.; Division of Cardiology, Duke University, Durham, North Carolina, USA., Keller VA; Heart and Vascular Center at Ochsner Lafayette General Hospital, Lafayette, Louisiana, USA., Strom J; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Wadhera RK; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Yeh RW; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2023 Jul 19; Vol. 2 (5), pp. 100415. Date of Electronic Publication: 2023 Jul 19 (Print Publication: 2023).
DOI:	10.1016/j.jacadv.2023.100415
Abstrakt:	Background: Transcatheter aortic valve implantation (TAVI) rates are lower among Black compared with White individuals. However, it is unclear whether racial residential segregation, which remains common in the United States, contributes to observed disparities in TAVI rates. Objectives: The purpose of this study was to evaluate the association between county-level racial segregation, and aortic stenosis (AS) diagnosis, management, and outcomes. Methods: We identified Black and White Medicare fee-for-service beneficiaries age ≥65 years living in metropolitan areas of the United States (2016-2019). Using the American Community Survey's Black-White residential segregation index, a measure of geographic racial distribution, we determined segregation in each beneficiary's county of residence. Using hierarchical modeling, we determined the association between racial segregation and rates of AS diagnosis, TAVI receipt, and 30-day clinical outcomes (mortality, readmission, stroke). Results: There were 29,264,075 beneficiaries, of whom 22% lived in a high-segregation county. Among Black beneficiaries, high-segregation county residence was associated with decreased rates of AS diagnosis (OR: 0.97; 95% CI: 0.96-0.98) and TAVI (OR: 0.89; 95% CI: 0.86-0.93) compared with low-segregation county residence. In contrast, among White beneficiaries, high-segregation county residence was associated with higher rates of AS diagnosis (OR: 1.02; 95% CI: 1.02-1.03) and no differences in TAVI (OR: 1.00; 95% CI: 0.99-1.00). Segregation and race were not independently associated with 30-day mortality. Conclusions: Among Black Medicare fee-for-service beneficiaries, living in a high-segregation county was independently associated with decreased rates of AS diagnosis and TAVI, an association not seen among White beneficiaries. Residential racial segregation may contribute to racial disparities seen in AS care. Competing Interests: This study was funded by 10.13039/100004374Medtronic. The study design, data analysis and manuscript preparation was performed independently by the investigator team without input from the funder. Dr Almarzooq has received research grant support from the Kuwait Foundation for the Advancement of Science. Dr Strom has received grant funding from Edwards Lifesciences, Anumana, Ultromics, EchoIQ, and HeartSciences; consulting for Bracco Diagnostics and GE Healthcare; speaker fees from Northwest Imaging Forums; and is on the Scientific Advisory Board for Edwards Lifesciences and EchoIQ. Dr Keller is a speaker and proctor for Medtronic Corporation, Edwards Lifesciences, and Stryker Corporation. Dr Wadhera has received consulting fees from CVS Health and Abbott outside the submitted work. Dr Yeh has received grant funding and consulting fees from Abbott Vascular, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2023 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu