Key result
Female sex linked to ~35% lower odds of receiving AVR following aortic stenosis diagnosis.
Why the study?
To assess gender, ethnicity, and deprivation-based differences in the provision of aortic valve replacement for adults with aortic stenosis in England.
Does female gender, ethnic minority status, or high social deprivation reduce the odds of receiving aortic valve replacement in adults with aortic stenosis?
Cohort (n=183,591)
Yes
Does female gender, ethnic minority status, or high social deprivation reduce the odds of receiving aortic valve replacement in adults with aortic stenosis?
Odds Ratio: 0.65 (95% CI 0.63–0.66)
Absolute Event Rate: 13.52% vs 20.34%
p-value: p=<0.001
Significant structural inequities exist in aortic stenosis management, with women, ethnic minorities, and socioeconomically deprived patients experiencing markedly lower and delayed provision of aortic valve replacement.
AVR access inequities by gender, ethnicity, and deprivation warrant clinical audits; leaves open causal mechanisms and intervention effects in aortic stenosis.
OBJECTIVE: To assess gender, ethnicity, and deprivation-based differences in provision of aortic valve replacement (AVR) in England for adults with aortic stenosis (AS). METHODS: We retrospectively identified adults with AS from the English Hospital Episode Statistics (HES) between April 2016 and March 2019 and those who subsequently had an AVR. We separately used HES-linked Clinical Practice Research Datalink (CPRD) to identify people with AVR and evaluate the timeliness of their procedure (CPRD-AVR cohort). ORs for AVR in people with an AS diagnosis were estimated using multivariable logistic regression adjusted for age, region and comorbidity. AVR was considered timely if performed electively and without evidence of cardiac decompensation before AVR. RESULTS: 183 591 adults with AS were identified in HES; of these, 31 436 underwent AVR. The CPRD-AVR cohort comprised 10 069 adults. Women had lower odds of receiving AVR compared with men (OR 0.65; 95% CI 0.63 to 0.66); as did people of black (OR 0.70; 95% CI 0.60 to 0.82) or South Asian (OR 0.75; 95% CI 0.69 to 0.82) compared with people of white ethnicities. People in the most deprived areas were less likely to receive AVR than the least deprived areas (OR 0.8; 95% CI 0.75 to 0.86). Timely AVR occurred in 65% of those of white ethnicities compared with 55% of both those of black and South Asian ethnicities. 77% of the least deprived had a timely procedure compared with 58% of the most deprived; there was no gender difference. CONCLUSIONS: In this large, national dataset, female gender, black or South Asian ethnicities and high deprivation were associated with significantly reduced odds of receiving AVR in England. A lower proportion of people of minority ethnicities or high deprivation had a timely procedure. Public health initiatives may be required to increase clinician and public awareness of unconscious biases towards minority and vulnerable populations to ensure timely AVR for everyone.
No takes yet. Share an insight, caveat, or question.
Rice et al. (2023) conducted a cohort in Aortic Stenosis (n=183,591). Female gender, minority ethnicity, or high social deprivation vs. Male gender, White ethnicity, or low social deprivation was evaluated on Receipt of aortic valve replacement (AVR) following an AS diagnosis (OR 0.65, 95% CI 0.63-0.66, p=<0.001). Female gender reduced the odds of receiving aortic valve replacement by 35% compared to males (OR 0.65), with similar disparities observed for Black/South Asian ethnicities and high social deprivation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: