Edward L Hannan1, Michael J Racz2, Gary Walford3, Alice K Jacobs4, Nicholas J Stamato5, Foster Gesten6, Peter B Berger7, Samin Sharma8, Spencer B King9. 1. Deptartment of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York, USA. Electronic address: elh03@health.state.ny.us. 2. Department of Statistics, Albany College of Pharmacy, Albany, New York, USA. 3. Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA. 4. Department of Cardiology, Boston Medical Center, Boston, Massachusetts, USA. 5. Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming, USA. 6. Office of Quality and Patient Safety, New York State Department of Health, Albany, New York, USA. 7. Department of Cardiology, North Shore Long Island Jewish Health Care System, Manhasset, New York, USA. 8. Department of Cardiology, Mt Sinai Medical Center, New York, New York, USA. 9. Department of Cardiology, St Joseph's Health System, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Many studies have shown that drug-eluting stents (DESs) are associated with better outcomes for patients receiving coronary stents, and earlier studies showed disparities in use by race and payer. It is of interest to know whether these differences persist in an era of higher use of DESs and to examine DES use differences across providers. METHODS: New York State's percutaneous coronary intervention registry was used to identify significant predictors of DES vs bare-metal stent use among patients receiving stents, including race, ethnicity, sex, payer, and numerous patient clinical risk factors in 2011-2012. Variations in DES use across hospitals and operators were also examined. RESULTS: African Americans (adjusted odds ratio [AOR], 0.70; 95% confidence interval [CI], 0.66-0.75) and Hispanics (AOR, 0.80; 95% CI, 0.74-0.85) were less likely to receive DESs than their counterparts. Patients with private insurance were more likely to receive DESs than patients in all other payer categories. More than one third of the 60 hospitals in the study had significantly lower adjusted use of DESs than the mean rate of 83%. For these hospitals, adjusted rates ranged from 52%-80%, and 5 of these hospitals had adjusted rates < 70%. Twenty-five percent of the total variation in the use of DESs was related to differences across hospitals that were unrelated to patient characteristics. CONCLUSIONS: Disparities by race, ethnicity, and insurance status persist in the use of DESs among patients receiving coronary stents. There are also large differences in use among hospitals that are unrelated to patient clinical characteristics and demographics.
BACKGROUND: Many studies have shown that drug-eluting stents (DESs) are associated with better outcomes for patients receiving coronary stents, and earlier studies showed disparities in use by race and payer. It is of interest to know whether these differences persist in an era of higher use of DESs and to examine DES use differences across providers. METHODS: New York State's percutaneous coronary intervention registry was used to identify significant predictors of DES vs bare-metal stent use among patients receiving stents, including race, ethnicity, sex, payer, and numerous patient clinical risk factors in 2011-2012. Variations in DES use across hospitals and operators were also examined. RESULTS: African Americans (adjusted odds ratio [AOR], 0.70; 95% confidence interval [CI], 0.66-0.75) and Hispanics (AOR, 0.80; 95% CI, 0.74-0.85) were less likely to receive DESs than their counterparts. Patients with private insurance were more likely to receive DESs than patients in all other payer categories. More than one third of the 60 hospitals in the study had significantly lower adjusted use of DESs than the mean rate of 83%. For these hospitals, adjusted rates ranged from 52%-80%, and 5 of these hospitals had adjusted rates < 70%. Twenty-five percent of the total variation in the use of DESs was related to differences across hospitals that were unrelated to patient characteristics. CONCLUSIONS: Disparities by race, ethnicity, and insurance status persist in the use of DESs among patients receiving coronary stents. There are also large differences in use among hospitals that are unrelated to patient clinical characteristics and demographics.
Authors: Ahmed N Mahmoud; Nikhil H Shah; Islam Y Elgendy; Nayan Agarwal; Akram Y Elgendy; Amgad Mentias; Amr F Barakat; Dhruv Mahtta; R David Anderson; Anthony A Bavry Journal: Clin Cardiol Date: 2018-01-25 Impact factor: 2.882
Authors: Christopher S G Murray; Cristian Zamora; Sanyog G Shitole; Panagiota Christa; Un Jung Lee; Anna E Bortnick; Jorge R Kizer; Carlos J Rodriguez Journal: Ethn Dis Date: 2022-07-21 Impact factor: 2.006