Journal of the American College of Cardiology
TCT-797 Equity in Cardiac Care: Analyzing Racial and Socioeconomic Disparities in Transcatheter Aortic Valve Replacement Access Using the Nationwide Inpatient Sample (2017-2021)
Chau Nguyen 1, Viet Nghi Tran 2, Huan Pham 3, Doan Ngoc Bach Nguyen 4, Thanh Thi Hoang 5, Thoai Phu Hoang 6, Phillip Tran 7
Transcatheter aortic valve replacement (TAVR) provides a crucial, less invasive option for severe aortic stenosis patients, representing an alternative to traditional surgical approaches for those at high risk. However, accessibility issues continue because of varying demographic and economic factors despite advancements in technology and procedures.
Our analysis used data from the National Inpatient Sample from 2017 to 2021, analyzing 147,008,163 adult admissions using sampling weighted methods for survey adjustment. We investigated TAVR rate variations across race, age, income levels, hospital regions, and ownership types. Statistical tools included chi-square tests and logistic regression to adjust TAVR ORs, factoring in hypertension, diabetes, chronic kidney disease, gender, the Charlson Comorbidity Index, and hospital characteristics.
Over 5 years, 621,305 TAVR procedures were recorded, revealing pronounced disparities in use. The lowest income quartile, with median incomes from $1 to $51,999, had a TAVR rate of 0.306%, whereas the highest quartile, with incomes above $88,000, showed a rate of 0.546%. The adjusted OR for undergoing TAVR in the highest vs lowest income quartile was 1.112 (95% CI: 1.064-1.163; P < 0.0001). Racial disparities were significant, with Black individuals having the lowest adjusted OR for TAVR at 0.347 (95% CI: 0.334-0.361; P < 0.0001) compared with Whites. No significant regional differences in TAVR rates were noted across the United States. Private, investor-owned hospitals had higher TAVR rates than government and nonprofit institutions. TAVR rates increased with patient age, peaking in those over 80 years old, with an OR of 22.566 (95% CI: 20.740-24.554; P < 0.0001).
Our results reveal significant racial and socioeconomic disparities in access to TAVR, highlighting the need for targeted health care initiatives to promote equitable treatment access. It is crucial to address these disparities to ensure that all eligible patients regardless of their socioeconomic status or racial background receive the best possible care.
ENDOVASCULAR: Diseases of the Aorta and Aortic Intervention.
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