Healthcare and health disparities and their impact on resource utilization and cost after transcatheter aortic valve replacement: A Nationwide Analysis of Real-World Data
Alexis K. Okoh1, Setri Fugar2, Molly Schultheis3, Aaron Fowler3, Aakash Shah3, Mariam Selevany3, Sari Kaplon3, Margarita Camacho3, Ravindra Karanam3, Leonard Lee4, Mark Russo4.
1RWJ Barnabas Health. Newark Beth Israel Medical Center, Woodbridge, NJ, USA, 2Rush University Medical Center, Chicago, NJ, USA, 3RWJ Barnabas Health. Newark Beth Israel Medical Center, Newark, NJ, USA, 4RWJ Barnabas Health. Rutgers Robert Wood Johnson University, New Brunswick, NJ, USA.
Objective: To investigate health and healthcare disparities after transcatheter aortic valve replacement (TAVR) and how they affect outcomes and resource utilization. Methods: We retrospectively reviewed TAVR patients from the National Inpatient Sample from 2012 to 2015. Patients were stratified by race and compared based on healthcare and health disparities. Outcomes were in-hospital complications, total procedural costs high resource utilization (HRU): length of stay ≥ 7 days or discharge to a location other than home. Results: Between 2012 and 2015, 57,830 patients who had TAVR in the United stated were stratified into African Americans (AA) (n=2265), Caucasians (CC) (n= 49,740), Hispanics (n=2265), Others (n=3,560). Compared to CC, Hispanics were more likely to undergo TAVR at low-volume (< 50 cases/year) centers (p< 0.0001). A higher number of AA and Hispanics than CC had TAVR at urban teaching centers (p=0.0003) and were less likely to be Medicare beneficiaries (p<0.0001). Distribution of TAVR patients in the lowest income quartile showed (AA: 49.5% vs. CC: 19.8% vs. Hispanic: 35% vs. Others: 17.3% p < 0.0001). In-hospital complications were higher among Hispanics than AA, CC and others (p=0.0007) and this translated to a prolonged LOS, costs and higher HRU. Independent predictors of HRU were (TAVR year: p< 0.0001, Sex (female): p<0.0001, Age: p <0.0001, lowest income quartile, p = 0.006 and insurance status (p=0.003).
Conclusions: There exist significant healthcare and health disparities among patients undergoing TAVR. Consequently, these unequal access to care and determinants of heath translate into higher costs and resource utilization.
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