title: Disparities in the Use of Drug-Eluting Coronary Stents by Race, Ethnicity, Payer, and Hospital.
abstract: Many studies have shown that drug-eluting stents (DESs) are associated with better outcomes for patients receiving coronary stents, and earlier studies showed disparities in use by race and payer. It is of interest to know whether these differences persist in an era of higher use of DESs and to examine DES use differences across providers.
  
  
  
  New York State's percutaneous coronary intervention registry was used to identify significant predictors of DES vs bare-metal stent use among patients receiving stents, including race, ethnicity, sex, payer, and numerous patient clinical risk factors in 2011-2012. Variations in DES use across hospitals and operators were also examined.
  
  
  
  African Americans (adjusted odds ratio [AOR], 0.70; 95% confidence interval [CI], 0.66-0.75) and Hispanics (AOR, 0.80; 95% CI, 0.74-0.85) were less likely to receive DESs than their counterparts. Patients with private insurance were more likely to receive DESs than patients in all other payer categories. More than one third of the 60 hospitals in the study had significantly lower adjusted use of DESs than the mean rate of 83%. For these hospitals, adjusted rates ranged from 52%-80%, and 5 of these hospitals had adjusted rates < 70%. Twenty-five percent of the total variation in the use of DESs was related to differences across hospitals that were unrelated to patient characteristics.
  
  
  
  Disparities by race, ethnicity, and insurance status persist in the use of DESs among patients receiving coronary stents. There are also large differences in use among hospitals that are unrelated to patient clinical characteristics and demographics.
authors.affiliation: Deptartment of Health Policy, Management and Behavior, University at Albany, State University of New York, Albany, New York, USA. Electronic address: elh03@health.state.ny.us.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: Department of Statistics, Albany College of Pharmacy, Albany, New York, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Racz
authors.affiliation: Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Walford
authors.affiliation: Department of Cardiology, Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Stamato
authors.affiliation: Office of Quality and Patient Safety, New York State Department of Health, Albany, New York, USA.
authors.forename: Foster
authors.initials: F
authors.lastname: Gesten
authors.affiliation: Department of Cardiology, North Shore Long Island Jewish Health Care System, Manhasset, New York, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: Department of Cardiology, Mt Sinai Medical Center, New York, New York, USA.
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, St Joseph's Health System, Atlanta, Georgia, USA.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D054855:Drug-Eluting Stents; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D017678:Sex Distribution; D012769:Shock / Q000453:epidemiology; D013318:Stroke Volume