title: Racial and gender disparities in implantable cardioverter-defibrillator placement: are they due to overuse or underuse?
abstract: Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men, to receive an ICD (adjusted OR = 0.48; 95% CI = 0.34-0.67). In this cohort, these differences appear related to overutilization among men and Whites who are discordant with ICD placement criteria in addition to underutilization among Blacks concordant with placement criteria.
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA. cookn2@nhlbi.nih.gov
authors.forename: Nakela L
authors.initials: NL
authors.lastname: Cook
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Liang
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: LeRoi S
authors.initials: LS
authors.lastname: Hicks
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D044383:Black People / Q000706:statistics & numerical data; D016022:Case-Control Studies; D017147:Defibrillators, Implantable / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011787:Quality of Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American