title: Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.
abstract: We sought to quantify socioeconomic disparities in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) at an urban, tertiary referral center.
  
  
  
  This retrospective case-control study identified 67 patients with severe AS (aortic valve [AV] area ≤1 cm2or AV area index ≤0.60 cm2/m2or AV velocity ≥40 mmHg) who underwent TAVR from November 5, 2013 to June 10, 2014. Study subjects were matched to controls with severe AS without TAVR in a 4:1 age-frequency match. Demographic data were collected using electronic medical records. Area-based median household income was obtained by geocoding patients' addresses and linking with census data. Charlson comorbidity index for all subjects was calculated.
  
  
  
  Income disparity was significant in that with every $10,000 increase in income, the odds of receiving TAVR increased by 10% (p = 0.05). Non-blacks were significantly more likely to receive TAVR than blacks (odds ratio [OR] 2.812, confidence interval [CI] 1.007-7.853; p = 0.048). No differences in comorbidities were found between the two groups. Post hoc analysis to identify etiologies of the found disparities examined differences of AV area and AV area index, indication for two-dimensional echocardiography (echo), symptoms prior to echo, and action after echo within the control group. Black race significantly impacted the TAVR status despite the same AV area (OR 0.33, CI 0.09-0.97, p = 0.043). After echo, blacks were more likely to decline AVR, be lost to follow-up, and not be referred to cardiology (OR 4.41, CI 1.43-13.64; p = 0.010).
  
  
  
  Socioeconomic and racial disparities were associated with patients with severe AS receiving TAVR at a major referral center. This study emphasizes the importance of improving access to standard of care for these subgroups of cardiac patients.
authors.affiliation: Formerly Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA. Anna.Sleder@stvincent.org.|Cardiovascular Services, St. Vincent Hospital, 8333 Naab Road, Ste 400, Indianapolis, IN, 46260, USA. Anna.Sleder@stvincent.org.
authors.forename: Anna
authors.initials: A
authors.lastname: Sleder
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Shiloh
authors.initials: S
authors.lastname: Tackett
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cerasale
authors.affiliation: Department of Medicine, University of Colorado, Denver, CO, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Mittal
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Iyad
authors.initials: I
authors.lastname: Isseh
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Ryhm
authors.initials: R
authors.lastname: Radjef
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Rashad
authors.initials: R
authors.lastname: Farha
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Oleksandra
authors.initials: O
authors.lastname: Lupak
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Larkin
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.affiliation: Community Health and Equity, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Kimberlydawn
authors.initials: K
authors.lastname: Wisdom
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Baker-Genaw
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D001024:Aortic Valve Stenosis / Q000208:ethnology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D062606:Tertiary Care Centers; D065467:Transcatheter Aortic Valve Replacement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
keywords: Aortic stenosis; Health disparities; Socioeconomic disparities; Transcatheter aortic valve replacement