Rupak Desai1, Sandeep Singh2, Hee Kong Fong3, Hemant Goyal4, Sonu Gupta5, Dipen Zalavadia6, Rajkumar Doshi7, Sejal Savani8, Samir Pancholy9, Rajesh Sachdeva10,11, Gautam Kumar1,11. 1. Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA. 2. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO, USA. 4. Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA. 5. Division of Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA. 6. Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA. 7. Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA. 8. Department of Public Health, New York University, New York, NY, USA. 9. Department of Cardiovascular Medicine, The Wright Center for Graduate Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA. 10. Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA. 11. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Abstract
BACKGROUND: There is a paucity of data regarding the racial and sex disparities in the outcomes of multi-vessel percutaneous coronary interventions (MVPCI). METHODS: The National Inpatient Sample (NIS) was examined for the years 2010 to 2014 to incorporate adult MVPCI-related hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. We excluded patients with the missing race or gender data from the final scrutiny. Discharge weights were used to obtain the national estimations. The principal outcomes were MVPCI-related racial and gender disparities in terms of the in-hospital mortality and complications, and diagnostic and therapeutic healthcare resource utilization. Secondary outcomes were the length of hospital stay (LOS) and hospitalization charges. We used the Chi-square test and t-test/ANOVA test to equate dichotomous and continuous variables respectively. A two-tailed P of <0.05 was considered clinically significant. RESULTS: An estimated 769,502 MVPCI-related hospitalizations were recorded from 2010 to 2014 after excluding patients with the missing data (70,954; 8.4%). Black male and female were the youngest (62±13, 64±14 years). The highest non-elective admissions (M: 72.8%, F: 71.2%) were reported among Hispanics. Non-whites showed a higher proportion of comorbidities with lower resource utilization than whites. Hispanic males (OR 1.23) showed the highest odds of the in-hospital mortality whereas among females, Asians (OR 1.51), blacks (OR 1.35), followed by Hispanics (OR 1.22) revealed higher odds of in-hospital mortality. Odds of cardiac complications were highest amongst Asians (M: OR 1.19, F: OR 1.40). Black (6±8 days) and Hispanic (7±9 days) showed the highest length of stay among males and females respectively. Total hospitalization charges were highest among Asians. There was a greater increase in the all-cause mortality in non-whites from 2010 to 2014. CONCLUSIONS: This study determines the existence of racial disparities in resource utilization and outcomes in MVPCI. There is an instant need for interventions designed to govern these healthcare discrepancies.
BACKGROUND: There is a paucity of data regarding the racial and sex disparities in the outcomes of multi-vessel percutaneous coronary interventions (MVPCI). METHODS: The National Inpatient Sample (NIS) was examined for the years 2010 to 2014 to incorporate adult MVPCI-related hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. We excluded patients with the missing race or gender data from the final scrutiny. Discharge weights were used to obtain the national estimations. The principal outcomes were MVPCI-related racial and gender disparities in terms of the in-hospital mortality and complications, and diagnostic and therapeutic healthcare resource utilization. Secondary outcomes were the length of hospital stay (LOS) and hospitalization charges. We used the Chi-square test and t-test/ANOVA test to equate dichotomous and continuous variables respectively. A two-tailed P of <0.05 was considered clinically significant. RESULTS: An estimated 769,502 MVPCI-related hospitalizations were recorded from 2010 to 2014 after excluding patients with the missing data (70,954; 8.4%). Black male and female were the youngest (62±13, 64±14 years). The highest non-elective admissions (M: 72.8%, F: 71.2%) were reported among Hispanics. Non-whites showed a higher proportion of comorbidities with lower resource utilization than whites. Hispanic males (OR 1.23) showed the highest odds of the in-hospital mortality whereas among females, Asians (OR 1.51), blacks (OR 1.35), followed by Hispanics (OR 1.22) revealed higher odds of in-hospital mortality. Odds of cardiac complications were highest amongst Asians (M: OR 1.19, F: OR 1.40). Black (6±8 days) and Hispanic (7±9 days) showed the highest length of stay among males and females respectively. Total hospitalization charges were highest among Asians. There was a greater increase in the all-cause mortality in non-whites from 2010 to 2014. CONCLUSIONS: This study determines the existence of racial disparities in resource utilization and outcomes in MVPCI. There is an instant need for interventions designed to govern these healthcare discrepancies.
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