title: Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation.
abstract: Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p <0.001]), black (0.49 [95% CI 0.44 to 0.55; p <0.001]), and Hispanic race (0.64 [95% CI 0.56 to 0.72; p <0.001]) were associated with lower likelihoods of undergoing an AF ablation. Medicare (0.93, 0.88 to 0.98, <0.001) or Medicaid (0.67, 0.59 to 0.76, <0.001) coverage and uninsured patients (0.55, 0.49 to 0.62, <0.001) also had lower rates of AF ablation compared to patients with private insurance. In conclusion we found differences in utilization of catheter ablation for AF based on gender, race, and insurance status that persisted over time.
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.affiliation: Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Ainani
authors.affiliation: Staten Island University Hospital, Staten Island, New York.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Nalluri
authors.affiliation: Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Staten Island University Hospital, Staten Island, New York.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert
authors.initials: R
authors.lastname: Hendel
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Juan
authors.initials: J
authors.lastname: Viles-Gonzalez
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Samuel
authors.initials: S
authors.lastname: Asirvatham
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Kaming
authors.initials: K
authors.lastname: Lo
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rmitrani@miami.edu.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People; D055815:Young Adult