Racial Gap in Transcatheter Aortic Valve Replacement Among US Adults with Aortic Stenosis

Among adult patients in the United States (US) with severe symptomatic aortic stenosis receiving transcatheter aortic valve replacement (TAVR), a significant gap exists between White patients and both Black and Hispanic patients, according to research findings presented at the American College of Cardiology 71st Annual Scientific Session & Expo, from April 2nd through 4th, in Washington, DC.

Candidates not well-suited for surgical aortic valve replacement have to seek alternative treatment, sometimes turning to TAVR. Racial disparities among Black and Hispanic patients in the use of TAVR lack investigation of the underlying issues. Researchers sought to investigate these disparities and estimate the relative importance of contributing factors.

They conducted a retrospective study of 2019 National Inpatient Sample (NIS) data of US adults, incorporating the Blinder-Oaxaca technique. This technique was used to determine the effect of sociodemographic characteristics, admission type, and hospital-specific factors on disparities in TAVR use in White vs Black (W-B) patients and White vs Hispanic (W-H) patients.

Among patients utilizing TAVR, researchers found a 12% gap between W-B patients and a 14% gap between W-H patients. Elective nature of hospital admissions (W-B: 56%; W-H: 46.3%) and patient age (W-B: 61.1%; W-H: 45.7%) were the major contributors to these gaps. Insurance status accounted for 10.5% of the W-H gap and 4.3% of the W-B gap. Socioeconomic status contributed 4.1% to the W-B gap. Hospital teaching status, gender profile of patients, and medical comorbidities contributed negatively to the W-B gap (-3%, -3%, and -18.8%, respectively).

In those patients undergoing TAVR, a significant gap exists between White patients and both Black and Hispanic patients, half of which is explained by the older age of White patients with aortic stenosis. The researchers wrote, “A significant and potentially modifiable contributor to the disparities in TAVR use was elective admissions to the hospital. Insurance and socioeconomic status also made significant contribution to TAVR use gap.”

Reference

Oyenubi O. Racial inequalities in the use of transcatheter aortic valve replacement among US adults with aortic stenosis: A Blinder-Oaxaca decomposition analysis. Presented at: American College of Cardiology 71st Annual Scientific Session & Expo; April 2-4, 2022; Washington, DC