Hospitals establishing TAVR programs treated fewer patients with dual Medicaid eligibility (difference -2.83%; 95% CI -3.78 to -1.89; P≤0.01) and those with higher median household incomes.
Observational
Yes
The diffusion of TAVR programs in the United States has been inequitable, with hospitals serving wealthier and less distressed communities being significantly more likely to establish programs.
Mean Difference: -2.83 (95% CI -3.78–-1.89)
p-value: p=≤0.01
Background: Despite the benefits of novel therapeutics, inequitable diffusion of new technologies may generate disparities. We examined the growth of transcatheter aortic valve replacement (TAVR) in the United States to understand the characteristics of hospitals that developed TAVR programs and the socioeconomic status of patients these hospitals served. Methods: We identified fee-for-service Medicare beneficiaries aged 66 years or older who underwent TAVR between January 1, 2012, and December 31, 2018, and hospitals that developed TAVR programs (defined as performing ≥10 TAVRs over the study period). We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between core-based statistical area level markers of socioeconomic status and TAVR rates. Results: Between 2012 and 2018, 583 hospitals developed new TAVR programs, including 572 (98. 1%) in metropolitan areas, and 293 (50. 3%) in metropolitan areas with preexisting TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated fewer patients with dual eligibility for Medicaid (difference of −2. 83% 95% CI, −3. 78% to −1. 89%, P ≤0. 01), higher median household incomes (difference 2447 95% CI, 1348–3547, P =0. 03), and from areas with lower distressed communities index scores (difference −4. 02 units 95% CI, −5. 43 to −2. 61, P ≤0. 01). After adjusting for the age, clinical comorbidities, race and ethnicity and socioeconomic status, areas with TAVR programs had higher rates of TAVR and TAVR rates per 100 000 Medicare beneficiaries were higher in core-based statistical areas with fewer dual eligible patients, higher median income, and lower distressed communities index scores. Conclusions: During the initial growth phase of TAVR programs in the United States, hospitals serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.
Nathan et al. (Thu,) conducted a observational in Transcatheter aortic valve replacement (TAVR). Establishing a TAVR program vs. Hospitals that did not start TAVR programs was evaluated on Dual eligibility for Medicaid (Difference -2.83%, 95% CI -3.78 to -1.89, p=≤0.01). Hospitals establishing TAVR programs treated fewer patients with dual Medicaid eligibility (difference -2.83%; 95% CI -3.78 to -1.89; P≤0.01) and those with higher median household incomes.
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