Rates of transcatheter aortic valve replacement (TAVR) are lower in areas with high Black and Hispanic populations and worse Distressed Communities Index (DCI) scores, suggesting potential racial, ethnic, and socioeconomic disparities, according to a study published in JAMA Cardiology.

The multicenter, cross-sectional study included Medicare claims data from 25 core-based statistical areas comprising 7590 zip codes nationwide. Medicare beneficiaries from these areas had a mean age of 71.4±2.0 years; 47.6±5.8% were men; 73.8±24.9% were White; 11.1±18.9% were Black; 8.0±12.9% were Hispanic; and 4.0%±7.0% were Asian. The mean DCI score was 28.6 (IQR, 11.9-56.1), and the median household income was $62,348 (IQR, $46,559-$83,206). All Medicare claims were made between January 1, 2012, and December 31, 2018.

The study’s primary outcome was the age-adjusted TAVR rate per 100,000 Medicare beneficiaries per zip code.


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Over the entire study population, researchers observed a mean of 249 (IQR, 0-429) TAVRs per 100,000 Medicare beneficiaries by zip code. With each $1000 decrease in a household’s median income level, there was a 0.2% (95% CI, 0.1-0.4) decrease in the rate of TAVR procedures per 100,000 Medicare beneficiaries (P =.002). The rate of TAVR procedures per 100,000 Medicare beneficiaries decreased 2.1% (95% CI, 1.3-2.9) with each 1% increase in the percentage of the population dually eligible for Medicaid (P <.001). The rate also decreased by 0.4% (95% CI, 0.2-0.5) with each 1-unit increase in DCI score (P <.001). After adjustments for age, clinical comorbidities, and socioeconomic markers, TAVR rates were lower in zip codes with a higher percentage of Black and Hispanic individuals.

Limitations to this study include a reliance on administrative data, a potential lack of generalizability, and the potential for survivor bias.

”Within major metropolitan areas in the US with TAVR programs, zip codes with higher proportions of Black and Hispanic patients and patients with greater socioeconomic disadvantages had lower rates of TAVR, adjusting for age and clinical comorbidities,” the study authors said. They added that similar results were observed for SAVR, which may indicate an “overall disparity” in treating patients with aortic stenosis.

“These findings highlight that access to health care services may require more than geographic proximity, but also surmounting structural racial, ethnic, and socioeconomic barriers to high-quality care,” the study authors noted.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Nathan AS, Yang L, Yang N, et al. Racial, ethnic, and socioeconomic disparities in access to transcatheter aortic valve replacement within major metropolitan areas. JAMA Cardiol. Published online November 17, 2021. doi:10.1001/jamacardio.2021.4641