Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease

Race based disparities in clinical and financial outcomes associated with major elective and emergent surgery

Background

Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.

Methods

All adult hospitalizations for AAA, CABG, and COL were identified using the 2011-2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.

Results

Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (p < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all p < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.

Conclusions

Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.

Racial and ethnic disparities in the prevalence, outcomes, and management of infective endocarditis in the United States

INTRODUCTION

Racial/ethnic differences in the prevalence, outcomes, and management of infective endocarditis (IE) remain unclear.

METHODS

We assessed racial/ethnic differences in the prevalence, baseline characteristics, surgical intervention (valve replacement/repair), and clinical outcomes of hospitalizations for IE from 2016 to 2021 using the National Inpatient Sample (NIS). A multivariable regression model was used to adjust for potential confounders.

RESULTS

A total of 78,600 hospitalizations for IE were identified, of which 76.7 % included White race, 10.7 % Black race, 7.7 % Hispanic ethnicity, and 4.9 % from other races/ethnicities. The median age was 51 (Interquartile Range [IQR] 34-67), and 41.1 % were female. Black race, Hispanic ethnicity, and other races/ethnicities were not associated with a significant difference in odds of receiving cardiac valve intervention when compared to White race. Black race (aOR 1.40; CI 1.08-1.80) was associated with higher odds of in-hospital mortality compared to White race. Black race, Hispanic ethnicity, and patients of other races/ethnicities were associated with higher odds of acute kidney injury requiring dialysis compared to White patients. Black race and patients of other races/ethnicities were associated with higher odds of cardiogenic shock when compared to White race. Black race was associated with lower odds of spleen infarction when compared to White patients.

CONCLUSION

Racial/ethnic disparities exist in the prevalence, outcomes, and management of patients hospitalized for IE in the US. Further studies are warranted to identify the reasons for such disparities and to guide policy initiatives to achieve equity.

Racial, ethnic, and sex disparities in the utilization and outcomes of tricuspid valve surgery

Background

Data on racial/ethnic and sex disparities in the utilization and outcomes of tricuspid valve surgery (TVS) in the United States are scarce. The authors aimed to evaluate the impact of race/ethnicity and sex on the utilization and outcomes of TVS.

Methods

The authors analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for TVS. Racial/ethnic and sex disparities in TVS outcomes were determined using logistic regression models.

Results

Between 2016 and 2020, 19 395 hospitalizations for TVS were identified. The utilization rate (number of surgeries/100,000 hospitalizations) was lower in Black and Hispanic patients compared with White patients for surgical tricuspid valve repair (STVr) (331 versus 493 versus 634, P<0.01) and surgical tricuspid valve replacement (STVR) (312 versus 601 versus 728, P<0.01). Similarly, the utilization rate was lower for women compared with men for STVr (1021 versus 1364, P<0.01) and STVR (930 versus 1,316, P<0.01). Compared to White men undergoing TVS, all women had lower odds of acute kidney injury [adjusted odds ratio (aOR) 0.65, 95% CI 0.55-0.78] and higher odds of blood transfusion (aOR 1.30, 95% CI 1.07-1.59), and Black men had higher odds of blood transfusion (aOR 1.59, 95% CI 1.08-2.35). In-hospital mortality and other surgical complications were similar between all groups (all P>0.05).

Conclusions

Significant racial/ethnic and sex disparities exist in the utilization of TVS in the United States. Further studies are needed to understand the reasons for these disparities and to identify effective strategies for their mitigation.

Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery: JACC State-of-the-Art Review

There has been little progress in reducing health care disparities since the 2003 landmark Institute of Medicine's report Unequal Treatment. Despite the higher burden of cardiovascular disease in underrepresented racial and ethnic groups, they have less access to cardiologists and cardiothoracic surgeons, and have higher rates of morbidity and mortality with cardiac surgical interventions. This review summarizes existing literature and highlights disparities in cardiovascular perioperative health care. We propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. Applying a health equity lens to multipronged interventions is necessary to eliminate the disparities in perioperative health care among patients undergoing cardiac surgery.

Health Inequities in Coronary Artery Bypass Grafting Literature: A Scoping Review

Although life saving, health inequities exist regarding access and patient outcomes in Coronary artery bypass grafting (CABG), especially among marginalized groups. This scoping review's goal is to outline existing literature and highlight gaps for future research. Researchers followed guidance from the Joanna Briggs Institute and PRISMA extension for scoping reviews. We conducted a search to identify articles published between 2016 and 2022 regarding CABG and inequity groups, defined by the National Institutes of Health. Fifty-seven articles were included in our final sample. Race/Ethnicity was examined in 39 incidences, Sex or Gender 29 times, Income 17 instances, Geography 10 instances, and Education Level 3 instances. Occupation Status 2 instances, and LGBTQ+ 0 times. Important disparities exist regarding CABG access and outcomes, especially involving members of the LGBTQ+, Native American, and Black communities. Further research is needed to address health disparities and their root causes for focused action and improved health of minoritized groups.

Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study

BACKGROUND

Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD.

METHODS

In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling.

RESULTS

The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)).

CONCLUSIONS

This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.