County-Level Racial Segregation and Transcatheter Aortic Valve Implantation

For the total population, living in a high-segregation county in the United States (US) is associated with increased rates of aortic stenosis (AS) diagnosis but no difference in rates of transcatheter aortic valve implantation (TAVI) vs living in a county with less segregation. For the Black population, living in a high-segregation county in the US is associated with decreased rates of AS diagnosis and decreased rates of TAVI. For the White population, living in a high-segregation county in the US is associated with increased rates of AS diagnosis and increased rates of TAVI. These are among the findings of a study presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5th through 7th, in Chicago, Illinois.

Researchers sought to evaluate the association between county-level racial segregation and rates of AS diagnosis and subsequent TAVI.

They conducted a review and analysis of 29,264,075 Black and White Medicare fee-for-service beneficiaries between 2016 and 2019 living in metropolitan areas. ICD-10 codes were used to calculate population-level rates of AS diagnosis and TAVI. Segregation in each beneficiary’s county of residence was determined using the American Community Survey’s residential segregation index (SI) that measures Black and White resident relative geographic distribution on a scale of 0 (complete integration) to 100 (complete segregation).

The researchers observed increased rates of AS diagnosis were associated with living in a high-segregation county (SI>60) for the total population (adjusted odds ratio, 1.03; 95% CI, 1.02-1.03) and no difference in TAVI rates. They found high county-level segregation was associated with decreased rates of AS diagnosis and decreased rates of TAVI among Black beneficiaries. They noted the same was not true of White beneficiaries who saw increased rates of AS diagnosis and increased rates of TAVI associated with living in counties with high-level segregation.

The researchers found the interaction between Black race and segregation, and lower TAVI rates continued among those with an AS diagnosis (interaction P =.003). They found no independent association for 30-day mortality with race or segregation.

Study limitations include the lack of long-term follow-up.

 “Living in a high-segregation county is independently associated with decreased population-level rates of AS diagnosis and receipt of TAVI for Black, but not White, individuals,” the study authors wrote. “Among Black people living in high-segregation counties, disparities in TAVI rates are associated with decreased AS diagnosis and access to TAVI.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.