Bahar Abdul Rasheed, Bahar Yasemin, Rabib Ali, Manasrah Nouraldeen, Onal Fethi, Bolaji Olayiwola, Abidov Aiden, Alraies M Chadi
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Department of Internal Medicine, Aiken Regional Medical Center, Aiken, South Carolina, USA.
JACC Adv. 2025 Sep 1;4(10 Pt 2):102099. doi: 10.1016/j.jacadv.2025.102099.
Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.
This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.
Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with P < 0.05 considered significant.
Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; P < 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; P = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; P < 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; P < 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; P = 0.022).
Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation.
在心血管介入治疗中，医疗保健可及性的差异依然存在。冠状动脉碎石术作为一种治疗钙化冠状动脉病变的新方法，其使用情况因社会人口统计学因素而存在差异。
本研究探讨性别、种族、收入和医院特征对美国冠状动脉碎石术使用情况的影响。
利用2021年全国住院患者样本，确定接受经皮冠状动脉介入治疗的患者。冠状动脉碎石术通过国际疾病分类第十版编码来定义。多变量逻辑回归评估社会人口统计学因素的影响，并对合并症和医院特征进行调整。使用倾向得分匹配法比较结果，P<0.05被认为具有统计学意义。
在261,260例接受经皮冠状动脉介入治疗的患者中，1000例（0.38%）接受了冠状动脉碎石术。校正分析显示，女性接受冠状动脉碎石术的可能性低于男性（校正比值比[aOR]：0.65；95%置信区间：0.53 - 0.79；P<0.001）。非裔美国患者接受冠状动脉碎石术的几率低于白人（aOR：0.66；95%置信区间：0.48 - 0.93；P = 0.016）。与医疗保险受益人相比，医疗补助患者接受冠状动脉碎石术的可能性较小（aOR：0.20；95%置信区间：0.11 - 0.36；P<0.001）。与低收入四分位数相比，高收入四分位数患者接受冠状动脉碎石术的几率增加（aOR：1.38 - 1.6；P<0.05）。存在地区差异，南部地区的使用率较低（aOR：0.66；95%置信区间：0.47 - 0.94；P = 0.022）。
冠状动脉碎石术的使用存在差异，受性别、种族、保险状况、收入和地理区域的影响。这些发现强调需要有针对性的干预措施，以促进公平获得先进的心血管治疗。虽然一些差异可能反映疾病患病率的不同，但治疗分配中持续存在的不平等值得进一步研究。
