To assess the link between zipping code-level racial, ethnic, and socioeconomic composition and rates of transcatheter aortic valve replacement (TAVR) in Medicare patients living in large metropolitan areas with TAVR programs. The multicenter, nationwide cross-sectional research of Medicare claims data from January 1, 2012, to December 31, 2018, included persons aged 66 years or older living in the 25 largest metropolitan core-based statistical areas. The association between zipping code level racial, ethnic, and socioeconomic composition and Medicare beneficiaries’ rates of TAVR per 100k. Within the researched metropolises, there were 7,590 unique zip code locations. The average (SD) age of Medicare recipients in these areas was 71.4 (2.0) years, with 47.6% (5.8%) of beneficiaries being men and 4.0% (7.0%) being Asian, 11.1% (18.9%) Black, 8.0% Hispanic, and 73. The mean number of TAVRs per 100,000 Medicare beneficiaries by zip code was 249 (IQR, 0-429). The number of TAVR operations performed per 100,000 Medicare beneficiaries decreased by 0.2% for each $1,000 decrease in median household income (95%CI, 0.1%-0.4%). (P=.002)The number of TAVR operations performed per 100,000 Medicare beneficiaries was 2.1% (95% CI, 1.3%-2.9%) lower for each 1% increase in the proportion of patients who were dually eligible for Medicaid services (P< .001). For each 1-unit increase in the Distressed Communities Index score, the number of TAVR processes practiced per 100,000 Medicare beneficiaries was 0.4% (95% CI, 0.2%-0.5%) lower (P<.001). Despite adjusting for socioeconomic indicators, age, and clinical comorbidities, zip codes with a higher proportion of Black individuals and Hispanics had lower TAVR rates. Zipcodes with higher proportions of Black and Hispanic patients, and those with more significant socioeconomic disadvantages had decreased mortality after TAVR when adjusted for age and clinical comorbidities throughout the United States with TAVR programs. Whether it reflected a racial and socioeconomic variation in the burden of symptomatic aortic stenosis or disparities in TAVR usage remains to be determined.
Link:jamanetwork.com/journals/jamacardiology/article-abstract/2786194
