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

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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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Author notes

  1. Anna Sleder

    Present address: Cardiovascular Services, St. Vincent Hospital, 8333 Naab Road, Ste 400, Indianapolis, IN, 46260, USA

Authors and Affiliations

  1. Formerly Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

    Anna Sleder

  2. Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

    Shiloh Tackett, Matthew Cerasale, Iyad Isseh, Ryhm Radjef, Rashad Farha, Oleksandra Lupak & Kimberly Baker-Genaw

  3. Department of Medicine, University of Colorado, Denver, CO, USA

    Chetan Mittal

  4. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    Andrew Taylor, Dana Larkin, Lois Lamerato & George Divine

  5. Community Health and Equity, Henry Ford Health System, Detroit, MI, USA

    Kimberlydawn Wisdom

  6. Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA

    William O’Neill

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  1. Anna Sleder
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  2. Shiloh Tackett
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  4. Chetan Mittal
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  15. William O’Neill
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Corresponding author

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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  • DOI: https://doi.org/10.1007/s40615-016-0325-x

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