Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort.
OBJECTIVE
Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare).


METHODS
We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES.


RESULTS
There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33-1.42,P< 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥$20,001 (OR: 1.07, 95% CI: 1.01-1.13,P- 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63-0.69,P< 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85-0.92,P< 0.001).


CONCLUSIONS
Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Tushar A
TA
Tuliani
Department of Cardiology, University of Florida, Gainesville, USA.
Maithili
M
Shenoy
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Milind
M
Parikh
Department of Cardiology, University of Miami - Miller School of Medicine, Miami, Florida, USA.
Mauricio G
MG
Cohen
Department of Cardiology, Wayne State University - Detroit Medical Center, Detroit, Michigan, USA.
Cindy
C
Grines
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Kenneth
K
Jutzy
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Anthony
A
Hilliard
Drug-eluting stent utilization; Medicare; sociodemographic factors