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Juarez JJ, Khalid MU, Ulloa BA, Romero CM, Maruthi R, Shah D, Chang E, Shafi I, Lakhter V, Zhao H, Rodriquez EJ, Pérez-Stable EJ, Bashir R. Racial and ethnic disparities in inferior vena cava filter placement for deep vein thrombosis in the United States. J Vasc Surg Venous Lymphat Disord 2024; 12:101683. [PMID: 37708935 DOI: 10.1016/j.jvsv.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We sought to determine whether racial and ethnic disparities existed in inferior vena cava (IVC) filter (IVCF) placement rates among Black and Latino patients for the treatment of acute proximal lower extremity (LE) deep vein thrombosis (DVT) in the United States from 2016 to 2019. METHODS We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal LE DVT from January 2016 to December 2019, including self-reported patient race and ethnicity. IVCF placement rates were identified using International Classification of Diseases, 10th revision, codes. Weighted multivariable logistic regression was used to compare IVCF use by race and ethnicity. The regression model was adjusted for patient demographics (ie, sex, primary payer, quartile classification of household income), hospital information (ie, region, location, teaching status, bed size), weekend admission, and clinical characteristics (ie, modified Charlson comorbidity index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, contraindications to anticoagulation, including other major bleeding). RESULTS Of 134,499 acute proximal LE DVT patients, 18,909 (14.1%) received an IVCF. Of the patients who received an IVCF, 12,733 were White (67.3%), 3563 were Black (18.8%), and 1679 were Latino (8.9%). IVCF placement decreased for all patient groups between 2016 and 2019. After adjusting for the U.S. population distribution, the IVCF placement rates were 11 to 12/100,000 persons for Black patients, 7 to 8/100,000 persons for White patients, and 4 to 5/100,000 persons for Latino patients. The difference in IVCF placement rates was statistically significant between patient groups (Black patients vs White patients, P < .05; Black patients vs Latino patients, P < .05; Latino patients vs White patients, P < .05). CONCLUSIONS This nationwide study showed that Black patients have higher IVCF placement rates compared with White and Latino patients. Given the known long-term complications and uncertain benefits of IVCFs, coupled with the 2010 U.S. Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias might be perpetuating this disparity.
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Affiliation(s)
- Jordan J Juarez
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Muhammad U Khalid
- Department of Vascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bianca A Ulloa
- Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, NY
| | - Carlos M Romero
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Rohit Maruthi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Devrat Shah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Eric Chang
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Irfan Shafi
- Division of Cardiovascular Medicine, Wayne State University, Detroit Medical Center, Detroit, MI
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Riyaz Bashir
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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Marchak K, Singh D, Malavia M, Trivedi P. A Review of Healthcare Disparities Relevant to Interventional Radiology. Semin Intervent Radiol 2023; 40:427-436. [PMID: 37927511 PMCID: PMC10622245 DOI: 10.1055/s-0043-1775878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed.
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Affiliation(s)
- Katherine Marchak
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Davinder Singh
- Division of Diagnostic Radiology/Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mira Malavia
- University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Premal Trivedi
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Trivedi PS, Guerra B, Kumar V, Akinwande G, West D, Abi-Jaoudeh N, Salazar G, Rochon P. Healthcare Disparities in Interventional Radiology. J Vasc Interv Radiol 2022; 33:1459-1467.e1. [PMID: 36058539 DOI: 10.1016/j.jvir.2022.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
Racial, ethnic, and sex-based healthcare disparities have been documented for the past several decades. Nonetheless, disparities remain firmly entrenched in our care delivery systems, with multiple contributing factors, including patient interactions with care providers, systemic barriers to access, and socioeconomic determinants of health. Interventional radiology is also subject to these drivers of health inequity. In this review, documented disparities for the most common conditions being addressed by interventional radiologists are summarized; their magnitude is quantified where relevant, and underlying drivers are identified. Specific examples are provided to illustrate how medical, cultural, and socioeconomic factors interact to produce unequal outcomes. By outlining known disparities and common contributors, this review aims to motivate future efforts to mitigate them.
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Affiliation(s)
- Premal S Trivedi
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Bernardo Guerra
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vishal Kumar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Goke Akinwande
- Midwest Institute for Non-Surgical Therapy, St. Louis, Missouri
| | - Derek West
- Department of Radiology, Emory School of Medicine, Atlanta, Georgia
| | - Nadine Abi-Jaoudeh
- Department of Radiology, University of California Irvine, Irvine, California
| | - Gloria Salazar
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Paul Rochon
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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