title: Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter-Defibrillator (ICD) Utilization: A United States Experience Over the Last Decade.
abstract: Prior studies have highlighted disparities in cardiac lifesaving procedure utilization, particularly among women and in minorities. Although there has been a significant increase in implantable cardioverter-defibrillator (ICD) insertion, socioeconomic disparities still exist in the trend of ICD utilization. With the use of the Nationwide Inpatient Sample from 2003 through 2011, we identified subjects with ICD insertion (procedure code 37.94) and cardiac resynchronization defibrillator (procedure code 00.50, 00.51) as codified by the International Classification of Diseases, Ninth Revision, Clinical Modification. Overall, 1 020 076 ICDs were implanted in the United States from 2003 to 2011. We observed an initial increase in ICD utilization by 51%, from 95 062 in 2003 to 143 262 in 2006, followed by a more recent decline. The majority of ICDs were implanted in men age ≥65 years. Implantation of ICDs was 2.5× more common in men than in women (402 per million vs 163 per million). Approximately 95% of the ICDs were implanted in insured patients, and 5% were used in the uninsured population. There has been a significant increase in ICD implantation in blacks, from 162 per million in 2003 to 291 per million in 2011. We found a significant difference in the volume of ICD implants between the insured and the uninsured patient populations. Racial disparities have narrowed significantly in comparison with those noted in earlier studies and are now more reflective of the population demographics at large. On the other hand, significant gender disparities continue to exist.
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio.
authors.forename: Sushruth
authors.initials: S
authors.lastname: Edla
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Nalluri
authors.affiliation: Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio.
authors.forename: Ronak
authors.initials: R
authors.lastname: Bhimani
authors.affiliation: Department of Internal Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Department of Cardiology, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Deepak
authors.initials: D
authors.lastname: Asti
authors.affiliation: Department of Cardiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York.
authors.forename: Valay
authors.initials: V
authors.lastname: Parikh
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Noseworthy
authors.affiliation: Department of Cardiology, University of Arkansas for Medical Science, Little Rock, Arkansas.
authors.forename: Hakan
authors.initials: H
authors.lastname: Paydak
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
authors.forename: Juan
authors.initials: J
authors.lastname: Viles-Gonzalez
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Department of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
mesh_terms: D001741:Black or African American; D000368:Aged; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data / Q000639:trends*; D004554:Electric Countershock / Q000295:instrumentation / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000639:trends*; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health / Q000639:trends*; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012737:Sex Factors; D013997:Time Factors; D014481:United States; D044465:White People