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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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| Published in: | PloS one 2023-04, Vol.18 (4), p.e0281811-e0281811 |
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| Main Authors: | , , , , , , , , , |
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| container_end_page | e0281811 |
| container_issue | 4 |
| container_start_page | e0281811 |
| container_title | PloS one |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1371/journal.pone.0281811 |
| format | article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0281811</identifier><identifier>PMID: 37036876</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>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</subject><ispartof>PloS one, 2023-04, Vol.18 (4), p.e0281811-e0281811</ispartof><rights>Copyright: © 2023 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Ahmed et al 2023 Ahmed et al</rights><rights>2023 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c693t-881010e6d3ff2ae3447cbf5194444616272293583eb76f49913cc7a1508924753</citedby><cites>FETCH-LOGICAL-c693t-881010e6d3ff2ae3447cbf5194444616272293583eb76f49913cc7a1508924753</cites><orcidid>0000-0002-6036-8929 ; 0000-0003-0416-9359 ; 0000-0002-9992-593X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2799001712/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2799001712?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,730,783,787,888,25765,27936,27937,37024,37025,44602,53804,53806,75454</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37036876$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Widmer, R. Jay</contributor><creatorcontrib>Ahmed, Yunus</creatorcontrib><creatorcontrib>van Bakel, Pieter A J</creatorcontrib><creatorcontrib>Hou, Hechuan</creatorcontrib><creatorcontrib>Sukul, Devraj</creatorcontrib><creatorcontrib>Likosky, Donald S</creatorcontrib><creatorcontrib>van Herwaarden, Joost A</creatorcontrib><creatorcontrib>Watkins, Daphne C</creatorcontrib><creatorcontrib>Ailawadi, Gorav</creatorcontrib><creatorcontrib>Patel, Himanshu J</creatorcontrib><creatorcontrib>Thompson, Michael P</creatorcontrib><creatorcontrib>Structural Heart and Aortic Diseases Outcomes Research Workgroup Investigators</creatorcontrib><creatorcontrib>for the Structural Heart and Aortic Diseases Outcomes Research Workgroup Investigators</creatorcontrib><title>Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.</description><subject>Aged</subject><subject>Aorta</subject><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Aortic valve stenosis</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - epidemiology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Asian Americans</subject><subject>Beneficiaries</subject><subject>Biology and Life Sciences</subject><subject>Cardiology</subject><subject>Care and treatment</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Cultural differences</subject><subject>Demographic aspects</subject><subject>Diagnosis</subject><subject>Echocardiography</subject><subject>Ethnic factors</subject><subject>Ethnicity</subject><subject>Evaluation</subject><subject>FDA approval</subject><subject>Government programs</subject><subject>Health care disparities</subject><subject>Healthcare Disparities</subject><subject>Heart surgery</subject><subject>Heart valves</subject><subject>Hispanic Americans</subject><subject>Humans</subject><subject>Medical diagnosis</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Minority & ethnic groups</subject><subject>Mortality</subject><subject>Patients</subject><subject>People and Places</subject><subject>Population</subject><subject>Population studies</subject><subject>Race</subject><subject>Racial Groups</subject><subject>Social Sciences</subject><subject>Surgery</subject><subject>Trends</subject><subject>United States - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahmed, Yunus</au><au>van Bakel, Pieter A J</au><au>Hou, Hechuan</au><au>Sukul, Devraj</au><au>Likosky, Donald S</au><au>van Herwaarden, Joost A</au><au>Watkins, Daphne C</au><au>Ailawadi, Gorav</au><au>Patel, Himanshu J</au><au>Thompson, Michael P</au><au>Widmer, R. Jay</au><aucorp>Structural Heart and Aortic Diseases Outcomes Research Workgroup Investigators</aucorp><aucorp>for the Structural Heart and Aortic Diseases Outcomes Research Workgroup Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-04-10</date><risdate>2023</risdate><volume>18</volume><issue>4</issue><spage>e0281811</spage><epage>e0281811</epage><pages>e0281811-e0281811</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37036876</pmid><doi>10.1371/journal.pone.0281811</doi><tpages>e0281811</tpages><orcidid>https://orcid.org/0000-0002-6036-8929</orcidid><orcidid>https://orcid.org/0000-0003-0416-9359</orcidid><orcidid>https://orcid.org/0000-0002-9992-593X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-04, Vol.18 (4), p.e0281811-e0281811 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2799001712 |
| source | PubMed (Medline); Publicly Available Content Database |
| 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 |
| title | Racial and ethnic disparities in diagnosis, management and outcomes of aortic stenosis in the Medicare population |
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