Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population
<h4>Importance</h4> Aortic stenosis (AS) is one of the most common heart valve conditions and its incidence and prevalence increases with age. With the introduction of transcatheter aortic valve replacement (TAVR), racial and ethnic disparities in AS diagnosis, treatment and outcomes is...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10085041/?tool=EBI |
| _version_ | 1797847192805834752 |
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| author | Yunus Ahmed Pieter A. J. van Bakel Hechuan Hou Devraj Sukul Donald S. Likosky Joost A. van Herwaarden Daphne C. Watkins Gorav Ailawadi Himanshu J. Patel Michael P. Thompson |
| author_facet | Yunus Ahmed Pieter A. J. van Bakel Hechuan Hou Devraj Sukul Donald S. Likosky Joost A. van Herwaarden Daphne C. Watkins Gorav Ailawadi Himanshu J. Patel Michael P. Thompson |
| author_sort | Yunus Ahmed |
| collection | DOAJ |
| description | <h4>Importance</h4> Aortic stenosis (AS) is one of the most common heart valve conditions and its incidence and prevalence increases with age. With the introduction of transcatheter aortic valve replacement (TAVR), racial and ethnic disparities in AS diagnosis, treatment and outcomes is poorly understood. <h4>Objective</h4> In this study we assessed racial and ethnic disparities in AS diagnosis, treatment, and outcomes among Medicare beneficiaries. <h4>Design</h4> We conducted a population-based cohort study of inpatient, outpatient, and professional claims from a 20% sample of Medicare beneficiaries <h4>Main outcomes and measures</h4> Incidence and Prevalence was determined among Medicare Beneficiaries. Outcomes in this study included management; the number of (non)-interventional cardiology and cardiothoracic surgery evaluation and management (E&M) visits, and number of transthoracic echocardiograms (TTE) performed. Treatment, which was defined as Surgical Aortic Valve Replacement and Transthoracic Aortic Valve Replacement. And outcomes described as All-cause Hospitalizations, Heart Failure Hospitalization and 1-year mortality. <h4>Results</h4> A total of 1,513,455 Medicare beneficiaries were diagnosed with AS (91.3% White, 4.5% Black, 1.1% Hispanic, 3.1% Asian and North American Native) between 2010 and 2018. Annual prevalence of AS diagnosis was lower for racial and ethnic minorities compared with White patients, with adjusted rate ratios of 0.66 (95% CI 0.65 to 0.68) for Black patients, 0.67 (95% CI 0.64 to 0.70) for Hispanic patients and 0.75 (95% CI 0.73 to 0.77) for Asian and North American Native patients as recent as 2018. After adjusting for age, sex and comorbidities, cardiothoracic surgery E&M visits and treatment rates were significantly lower for Black, Hispanic and Asian and North American Native patients compared with White patients. All-cause hospitalization rate was higher for Black and Hispanic patients compared with White patient. 1-year mortality was higher for Black patients, while Hispanic and Asian and North American Native patients had lower 1-year mortality compared with White patients. <h4>Conclusions and relevance</h4> We demonstrated significant racial and ethnic disparities in the diagnosis, management and outcomes of AS. The factors driving the persistence of these disparities in AS care need to be elucidated to develop an equitable health care system. |
| first_indexed | 2024-04-09T18:07:20Z |
| format | Article |
| id | doaj.art-e9b2917da15343af9a880ddb6844e812 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T18:07:20Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e9b2917da15343af9a880ddb6844e8122023-04-14T05:31:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01184Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare populationYunus AhmedPieter A. J. van BakelHechuan HouDevraj SukulDonald S. LikoskyJoost A. van HerwaardenDaphne C. WatkinsGorav AilawadiHimanshu J. PatelMichael P. Thompson<h4>Importance</h4> Aortic stenosis (AS) is one of the most common heart valve conditions and its incidence and prevalence increases with age. With the introduction of transcatheter aortic valve replacement (TAVR), racial and ethnic disparities in AS diagnosis, treatment and outcomes is poorly understood. <h4>Objective</h4> In this study we assessed racial and ethnic disparities in AS diagnosis, treatment, and outcomes among Medicare beneficiaries. <h4>Design</h4> We conducted a population-based cohort study of inpatient, outpatient, and professional claims from a 20% sample of Medicare beneficiaries <h4>Main outcomes and measures</h4> Incidence and Prevalence was determined among Medicare Beneficiaries. Outcomes in this study included management; the number of (non)-interventional cardiology and cardiothoracic surgery evaluation and management (E&M) visits, and number of transthoracic echocardiograms (TTE) performed. Treatment, which was defined as Surgical Aortic Valve Replacement and Transthoracic Aortic Valve Replacement. And outcomes described as All-cause Hospitalizations, Heart Failure Hospitalization and 1-year mortality. <h4>Results</h4> A total of 1,513,455 Medicare beneficiaries were diagnosed with AS (91.3% White, 4.5% Black, 1.1% Hispanic, 3.1% Asian and North American Native) between 2010 and 2018. Annual prevalence of AS diagnosis was lower for racial and ethnic minorities compared with White patients, with adjusted rate ratios of 0.66 (95% CI 0.65 to 0.68) for Black patients, 0.67 (95% CI 0.64 to 0.70) for Hispanic patients and 0.75 (95% CI 0.73 to 0.77) for Asian and North American Native patients as recent as 2018. After adjusting for age, sex and comorbidities, cardiothoracic surgery E&M visits and treatment rates were significantly lower for Black, Hispanic and Asian and North American Native patients compared with White patients. All-cause hospitalization rate was higher for Black and Hispanic patients compared with White patient. 1-year mortality was higher for Black patients, while Hispanic and Asian and North American Native patients had lower 1-year mortality compared with White patients. <h4>Conclusions and relevance</h4> We demonstrated significant racial and ethnic disparities in the diagnosis, management and outcomes of AS. The factors driving the persistence of these disparities in AS care need to be elucidated to develop an equitable health care system.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10085041/?tool=EBI |
| spellingShingle | Yunus Ahmed Pieter A. J. van Bakel Hechuan Hou Devraj Sukul Donald S. Likosky Joost A. van Herwaarden Daphne C. Watkins Gorav Ailawadi Himanshu J. Patel Michael P. Thompson Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population PLoS ONE |
| title | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
| title_full | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
| title_fullStr | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
| title_full_unstemmed | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
| title_short | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
| title_sort | racial and ethnic disparities in diagnosis management and outcomes of aortic stenosis in the medicare population |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10085041/?tool=EBI |
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