Intra-aortic Balloon Pump Utilization Prior to Coronary Artery Bypass Grafting: Social Determinants of Health

Abstract Background Disparities in health care access and utilization have been widely documented in cardiovascular interventions. The intra-aortic balloon pump (IABP), a critical mechanical circulatory device used in high-risk coronary artery bypass graft (CABG) patients, has shown significant variability in utilization across sociodemographic groups. This study examines the influence of social determinants of health, including sex, race, ethnicity, income, and insurance status, on IABP utilization prior to CABG. Methods This retrospective cohort study utilized the Nationwide Inpatient Sample from 2016-2021 to identify patients undergoing CABG. IABP use was defined as preoperative utilization in patients awaiting CABG. Multivariable logistic regression analyzed the impact of sociodemographic factors on IABP use, adjusting for baseline comorbidities and hospital characteristics. Propensity score matching was employed to compare in-hospital outcomes between IABP and non-IABP groups. Statistical significance was set at P < .05. Results Of 471,985 CABG patients, IABP was utilized in 14,535 patients (3.1%) preoperatively. Adjusted analyses revealed significant disparities: women were less likely to receive IABP, while Hispanic and Asian patients were more likely to receive IABP compared to Whites. Medicaid coverage increased the odds of IABP use, whereas income quartiles showed no significant impact. Regional disparities were noted, with lower odds of IABP use in the South and West. Weekend admissions were associated with higher IABP utilization. Subgroup analysis identified higher IABP use among Hispanic men and women. Conclusions Significant disparities in IABP utilization exist across sociodemographic and regional lines, with lower use among women and patients in the South and West regions, and higher use among Hispanic and Asian patients. These findings underscore the presence of sex-based disparities and significant variation in racial/ethnic patterns of IABP utilization, highlighting the need for further investigation and targeted interventions to ensure equitable application of advanced cardiovascular therapies.