Racial, ethnic, socioeconomic, and geographic inequities in catheter ablation for atrial fibrillation

BACKGROUND: Catheter ablation is effective in the treatment of atrial fibrillation (AF), however, it requires a significant amount of resources that may not be available in all areas. OBJECTIVE: We sought to understand geographic, racial, ethnic, and socioeconomic differences in the utilization of catheter ablation for AF. METHODS: Medicare fee-for-service beneficiaries with a diagnosis of AF were identified from the Medicare Inpatient and Outpatient data files between 2016 and 2019. To study inequities in utilization, we generated Generalized Estimating Equations to model the association between ZIP code-level racial, ethnic, and socioeconomic composition and ZIP code-level catheter ablation rates among patients with AF. RESULTS: For each 10% increase in the percentage of patients who were dual-eligible for Medicaid (a marker of poverty) in a ZIP code, 275 fewer patients per 10,000 underwent AF ablation (P = .0003). After adjusting for dual-eligible status, for each 10% increase in the percentage of Black patients in a ZIP code, 618 fewer underwent AF ablation (P < .0001), whereas for each 10% increase in the percentage of Hispanic patients, 430 fewer underwent AF ablation (P = .002). CONCLUSION: There are significant inequities in utilization of AF ablation, associated with racial, ethnic, and socioeconomic differences. Inequitable utilization in marginalized groups of patients may generate and propagate inequities in health.