title: African-American patients are less likely to receive drug-eluting stents during percutaneous coronary intervention.
abstract: BACKGROUND
  Previous research has shown that African-Americans, patients without insurance, and those with government-sponsored insurance are less likely to be referred for invasive cardiovascular procedures. We therefore sought to compare the impact of race and insurance type upon the use of drug-eluting stents (DES).
  
  
  METHODS
  Patients undergoing percutaneous coronary intervention (PCI) with stenting from January 2008 to December 2012 at Los Angeles County Hospital and Keck Hospital of USC were retrospectively analyzed. Race was categorized as African-American, Hispanic, or non-African-American/non-Hispanic. Insurance was categorized as private, Medicare, Medicaid, incarcerated, or uninsured. Multivariable logistic regression was performed, with receipt of ≥1 DES the outcome variable of interest.
  
  
  RESULTS
  Among 2763 patients undergoing PCI, 62.8% received ≥1 DES, 45.4% were Hispanic, 6.7% were African-American, 33.2% were uninsured, 28.5% had Medicaid, 22.5% had Medicare, 14.1% had private insurance, and 1.7% were incarcerated. Following multivariable adjustment, African-Americans, in comparison to non-African-American/non-Hispanic patients, were less likely to receive ≥1 DES (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.40-0.82, p=0.002). Hispanic patients, however, were not less likely to receive DES. Uninsured patients (OR 1.51, 95% CI 1.13-2.03, p=0.006) and those with Medicaid (OR 1.49, 95% CI 1.11-2.00, p=0.008) were more likely to receive DES than patients with private insurance, whereas those with Medicare were less likely to receive DES (OR 0.71, 95% CI 0.52-0.95, p=0.02).
  
  
  CONCLUSIONS
  African-American race continues to have a significant impact upon the decision to use DES. Future research should focus upon patient and provider perceptions at the time of PCI.
  
  
  CONCLUSIONS
  This study is a retrospective analysis of the impact of race and insurance status upon the utilization of drug-eluting stents. Multivariable logistic regression showed that African-American race was associated with less utilization of drug-eluting stents.
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine. Electronic address: mgaglia@usc.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: Han
authors.initials: H
authors.lastname: Tun
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: Jiken
authors.initials: J
authors.lastname: Bhatt
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: Anilkumar
authors.initials: A
authors.lastname: Mehra
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: Ray V
authors.initials: RV
authors.lastname: Matthews
authors.affiliation: University of Southern California Keck School of Medicine, Division of Cardiovascular Medicine.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Clavijo
mesh_terms: D001741:Black or African American; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D054855:Drug-Eluting Stents / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008484:Medicaid; D017057:Medically Uninsured; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data; D017149:Private Sector; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: Drug-eluting stents; Healthcare disparities; Insurance; Race