Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, United States of America.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2023 Apr 10;18(4):e0281811. doi: 10.1371/journal.pone.0281811. eCollection 2023.
Aortic stenosis (AS) is one of the most common heart valve conditions and its incidence and prevalence increases with age. With the introduction of transcatheter aortic valve replacement (TAVR), racial and ethnic disparities in AS diagnosis, treatment and outcomes is poorly understood.
In this study we assessed racial and ethnic disparities in AS diagnosis, treatment, and outcomes among Medicare beneficiaries.
We conducted a population-based cohort study of inpatient, outpatient, and professional claims from a 20% sample of Medicare beneficiaries.
Incidence and Prevalence was determined among Medicare Beneficiaries. Outcomes in this study included management; the number of (non)-interventional cardiology and cardiothoracic surgery evaluation and management (E&M) visits, and number of transthoracic echocardiograms (TTE) performed. Treatment, which was defined as Surgical Aortic Valve Replacement and Transthoracic Aortic Valve Replacement. And outcomes described as All-cause Hospitalizations, Heart Failure Hospitalization and 1-year mortality.
A total of 1,513,455 Medicare beneficiaries were diagnosed with AS (91.3% White, 4.5% Black, 1.1% Hispanic, 3.1% Asian and North American Native) between 2010 and 2018. Annual prevalence of AS diagnosis was lower for racial and ethnic minorities compared with White patients, with adjusted rate ratios of 0.66 (95% CI 0.65 to 0.68) for Black patients, 0.67 (95% CI 0.64 to 0.70) for Hispanic patients and 0.75 (95% CI 0.73 to 0.77) for Asian and North American Native patients as recent as 2018. After adjusting for age, sex and comorbidities, cardiothoracic surgery E&M visits and treatment rates were significantly lower for Black, Hispanic and Asian and North American Native patients compared with White patients. All-cause hospitalization rate was higher for Black and Hispanic patients compared with White patient. 1-year mortality was higher for Black patients, while Hispanic and Asian and North American Native patients had lower 1-year mortality compared with White patients.
We demonstrated significant racial and ethnic disparities in the diagnosis, management and outcomes of AS. The factors driving the persistence of these disparities in AS care need to be elucidated to develop an equitable health care system.
主动脉瓣狭窄（AS）是最常见的心脏瓣膜疾病之一，其发病率和患病率随着年龄的增长而增加。随着经导管主动脉瓣置换术（TAVR）的引入，种族和民族差异在 AS 的诊断、治疗和结局方面的了解甚少。
本研究评估了医疗保险受益人群中 AS 的诊断、治疗和结局方面的种族和民族差异。
我们对医疗保险受益人群的 20%抽样进行了住院、门诊和专业索赔的基于人群的队列研究。
在医疗保险受益人群中确定了发病率和患病率。本研究中的结果包括管理；非介入性心脏病学和心胸外科评估和管理（E&M）就诊次数，以及进行的经胸超声心动图（TTE）次数。治疗定义为主动脉瓣置换术和经胸主动脉瓣置换术。结果描述为全因住院、心力衰竭住院和 1 年死亡率。
2010 年至 2018 年间，共有 1513455 名医疗保险受益患者被诊断患有 AS（91.3%为白人，4.5%为黑人，1.1%为西班牙裔，3.1%为亚裔和北美原住民）。与白人患者相比，少数民族的 AS 诊断年度患病率较低，调整后的比率分别为 0.66（95%CI 0.65 至 0.68）黑人患者，0.67（95%CI 0.64 至 0.70）西班牙裔患者，0.75（95%CI 0.73 至 0.77）为 2018 年的亚裔和北美原住民患者。在调整年龄、性别和合并症后，与白人患者相比，黑人、西班牙裔和亚裔及北美原住民患者的心胸外科 E&M 就诊次数和治疗率明显较低。黑人患者和西班牙裔患者的全因住院率高于白人患者。黑人患者的 1 年死亡率较高，而西班牙裔和亚裔及北美原住民患者的 1 年死亡率低于白人患者。
我们发现在 AS 的诊断、管理和结局方面存在显著的种族和民族差异。需要阐明导致 AS 护理中这些差异持续存在的因素，以建立公平的医疗保健系统。
