Key result
Black patients concordant with ICD placement criteria were less likely than White patients to receive an ICD (adjusted OR 0.24; 95% CI 0.08-0.71), indicating underutilization.
Why the study?
Racial and gender disparities in ICD placement have been documented, but it is unclear whether these disparities are due to underutilization or overutilization.
Do race and gender affect the appropriate utilization of implantable cardioverter-defibrillators in adults hospitalized with ventricular arrhythmias?
Cohort (n=1,054)
No
Do race and gender affect the appropriate utilization of implantable cardioverter-defibrillators in adults hospitalized with ventricular arrhythmias?
Odds Ratio: 0.24 (95% CI 0.08–0.71)
Racial and gender disparities in ICD placement are driven by both underutilization in eligible Black patients and overutilization in ineligible White and male patients.
Racial disparities in ICD receipt warrant equity review; leaves open whether unmeasured factors explain the association.
Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men, to receive an ICD (adjusted OR = 0.48; 95% CI = 0.34-0.67). In this cohort, these differences appear related to overutilization among men and Whites who are discordant with ICD placement criteria in addition to underutilization among Blacks concordant with placement criteria.
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Cook et al. (2010) conducted a cohort in ventricular arrhythmias (n=1,054). Black race vs. White race was evaluated on ICD placement among patients with clinical indicators concordant with placement criteria (adjusted OR 0.24, 95% CI 0.08-0.71). Black patients concordant with ICD placement criteria were less likely than White patients to receive an ICD (adjusted OR 0.24; 95% CI 0.08-0.71), indicating underutilization.
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