Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population

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. In this study...

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Bibliographic Details
Published in:PloS one 2023-04, Vol.18 (4), p.e0281811-e0281811
Main Authors: Ahmed, Yunus, van Bakel, Pieter A J, Hou, Hechuan, Sukul, Devraj, Likosky, Donald S, van Herwaarden, Joost A, Watkins, Daphne C, Ailawadi, Gorav, Patel, Himanshu J, Thompson, Michael P
Format: Article
Language:English
Subjects:
Aged
Aorta
Aortic stenosis
Aortic valve
Aortic valve stenosis
Aortic Valve Stenosis - diagnosis
Aortic Valve Stenosis - epidemiology
Aortic Valve Stenosis - surgery
Asian Americans
Beneficiaries
Biology and Life Sciences
Cardiology
Care and treatment
Cohort Studies
Comorbidity
Congestive heart failure
Cultural differences
Demographic aspects
Diagnosis
Echocardiography
Ethnic factors
Ethnicity
Evaluation
FDA approval
Government programs
Health care disparities
Healthcare Disparities
Heart surgery
Heart valves
Hispanic Americans
Humans
Medical diagnosis
Medicare
Medicine and Health Sciences
Minority & ethnic groups
Mortality
Patients
People and Places
Population
Population studies
Race
Racial Groups
Social Sciences
Surgery
Trends
United States - epidemiology
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Description
Summary: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. In this study we assessed racial and ethnic disparities in AS diagnosis, treatment, and outcomes among Medicare beneficiaries. We conducted a population-based cohort study of inpatient, outpatient, and professional claims from a 20% sample of Medicare beneficiaries. 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. 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. 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0281811