Division of Cardiovascular Disease, University of Miami Miller School of Medicine, JFK Hospital, Atlantis, Florida.
Division of Cardiology, Cleveland Clinic Florida, Weston, Florida.
Am J Cardiol. 2023 Oct 1;204:53-63. doi: 10.1016/j.amjcard.2023.07.040. Epub 2023 Aug 1.
Racial and ethnic disparities in the access to left atrial appendage occlusion (LAAO) have been previously described. However, it remains unclear if there have been any changes in these disparities over the years and if the disparities include other racial and ethnic groups not previously studied. We aimed to determine the temporal evolution of the racial and ethnic disparities in the utilization of LAAO from 2016 to 2019. We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2019. International Classification of Diseases, 10th edition codes were used to identify all adult admissions with atrial fibrillation (AF) and those who underwent LAAO. The sample was divided into Asian American and Pacific Islander, Black, Hispanic, White, and other races/ethnicities. Our primary outcome was the utilization of LAAO in patients admitted with a diagnosis of AF. The Cochran-Armitage test was conducted to evaluate the yearly trend in LAAO utilization stratified by race/ethnicity. Multivariable regression analysis was conducted to assess the association of race/ethnicity with multiple end points. A total of 59,415 patients underwent LAAO. The highest yearly increase in LAAO utilization was seen in White patients (trend: 0.16%, p <0.001). Furthermore, compared with White patients, the yearly increase in LAAO utilization was lower in all other racial/ethnic groups. Black patients had the lowest odds of who underwent LAAO (odds ratio = 0.45, 95% confidence interval 0.40 to 0.50, p <0.001). In conclusion, significant gaps exist in the utilization of LAAO between racial and ethnic groups, and they appear to continue worsening from 2016 to 2019.
种族和民族在接受左心耳封堵术（LAAO）方面存在差异，这一点以前已经有过描述。然而，目前尚不清楚这些差异在这些年来是否有所改变，以及这些差异是否包括以前没有研究过的其他种族和民族。我们的目的是确定从 2016 年到 2019 年，LAAO 利用方面的种族和民族差异的时间演变。我们使用 2016 年至 2019 年的国家住院患者样本进行了回顾性队列研究。使用国际疾病分类，第 10 版代码来识别所有患有心房颤动（AF）并接受 LAAO 治疗的成年住院患者。该样本分为亚裔美国人/太平洋岛民、黑人、西班牙裔、白人和其他种族/民族。我们的主要结果是在诊断为 AF 的患者中使用 LAAO。通过 Cochran-Armitage 检验评估了按种族/民族分层的 LAAO 利用的年度趋势。多变量回归分析用于评估种族/民族与多个终点的相关性。共有 59415 名患者接受了 LAAO。LAAO 使用率最高的年度增长见于白人患者（趋势：0.16%，p<0.001）。此外，与白人患者相比，所有其他种族/民族群体的 LAAO 使用率的年度增长较低。黑人患者接受 LAAO 的几率最低（比值比=0.45，95%置信区间 0.40 至 0.50，p<0.001）。总之，种族和民族之间在 LAAO 的利用方面存在显著差距，而且从 2016 年到 2019 年，这种差距似乎还在继续恶化。
