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Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

Abstract

Background

We sought to quantify socioeconomic disparities in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) at an urban, tertiary referral center.

Methods

This retrospective case-control study identified 67 patients with severe AS (aortic valve [AV] area ≤1 cm2 or AV area index ≤0.60 cm2/m2 or AV velocity ≥40 mmHg) who underwent TAVR from November 5, 2013 to June 10, 2014. Study subjects were matched to controls with severe AS without TAVR in a 4:1 age-frequency match. Demographic data were collected using electronic medical records. Area-based median household income was obtained by geocoding patients’ addresses and linking with census data. Charlson comorbidity index for all subjects was calculated.

Results

Income disparity was significant in that with every $10,000 increase in income, the odds of receiving TAVR increased by 10% (p = 0.05). Non-blacks were significantly more likely to receive TAVR than blacks (odds ratio [OR] 2.812, confidence interval [CI] 1.007–7.853; p = 0.048). No differences in comorbidities were found between the two groups. Post hoc analysis to identify etiologies of the found disparities examined differences of AV area and AV area index, indication for two-dimensional echocardiography (echo), symptoms prior to echo, and action after echo within the control group. Black race significantly impacted the TAVR status despite the same AV area (OR 0.33, CI 0.09–0.97, p = 0.043). After echo, blacks were more likely to decline AVR, be lost to follow-up, and not be referred to cardiology (OR 4.41, CI 1.43–13.64; p = 0.010).

Conclusion

Socioeconomic and racial disparities were associated with patients with severe AS receiving TAVR at a major referral center. This study emphasizes the importance of improving access to standard of care for these subgroups of cardiac patients.

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Correspondence to Anna Sleder.

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Funding

No funding was received for this study.

Conflict of Interest

Dr. O’Neill has served as a proctor and consultant for Edwards Lifesciences, has served as a consultant for St. Jude Medical and Medtronic, and is the director of Neovasc Inc. All other authors declare that they have no conflict of interest.

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Sleder, A., Tackett, S., Cerasale, M. et al. Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis. J. Racial and Ethnic Health Disparities 4, 1189–1194 (2017). https://doi.org/10.1007/s40615-016-0325-x

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Keywords

  • Transcatheter aortic valve replacement
  • Health disparities
  • Aortic stenosis
  • Socioeconomic disparities