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Structural Inequities In The Adoption Of Percutaneous Coronary Intervention Services By US Hospitals, 2000-20
1Renee Y. Hsia (renee.hsia@ucsf.edu), University of California San Francisco, San Francisco, California.
Insights
Hospitals in segregated communities, particularly those serving Black and Hispanic populations, are less likely to offer critical heart attack treatments like percutaneous coronary intervention (PCI). This disparity highlights access barriers in underserved areas.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Equity
Background:
- Percutaneous coronary intervention (PCI) is a vital procedure for treating heart attacks.
- Timely access to PCI services is crucial for patient survival.
- Disparities in PCI service availability may exist across different community types.
Purpose of the Study:
- To examine trends in PCI service adoption by US hospitals.
- To analyze how community characteristics (race, ethnicity, income, rurality, segregation) influence PCI adoption.
- To identify potential barriers to critical cardiac care access.
Main Methods:
- Cohort study of 5,260 US general acute care hospitals from 2000-2020.
- Analysis of PCI service adoption based on community racial, ethnic, income, and rurality stratification.
- Comparison of adoption rates in segregated versus integrated communities.
Main Results:
- Hospitals in Black, racially segregated communities were 48% less likely to adopt PCI.
- Hospitals in Hispanic, ethnically segregated communities were 41% less likely to adopt PCI.
- High-income, integrated communities showed higher PCI adoption (1.8x) than segregated ones; rural hospitals lagged behind urban.
Conclusions:
- PCI service adoption is unevenly distributed, with significant disparities linked to community segregation and demographics.
- Racial and ethnic segregation are associated with lower PCI adoption rates.
- Addressing these disparities is essential for improving equitable access to life-saving cardiac interventions.
Abstract:
Percutaneous coronary intervention (PCI) is a procedure that opens blocked arteries and restores blood flow to the heart. Timely access to hospitals offering PCI services can be a matter of life or death for patients experiencing a heart attack; however, hospitals' adoption of PCI services may vary between communities, posing potential barriers to critical care. Our cohort study of US general acute hospitals during the period 2000-20 examined PCI service adoption across communities stratified by race, ethnicity, income, and rurality and further classified as segregated or integrated. Of 5,260 hospitals, 1,621 offered PCI services in 2020 or before, 630 added PCI services between 2001 and 2010, and 225 added PCI services between 2011 and 2020. Hospitals serving Black, racially segregated communities were 48 percent less likely to adopt PCI services compared with hospitals serving non-Black, racially segregated communities, and hospitals serving Hispanic, ethnically segregated communities were 41 percent less likely to do so than those serving non-Hispanic, ethnically segregated communities. Hospitals in high-income, economically integrated communities were 1.8 times more likely to adopt PCI services than those in high-income, economically segregated communities, and rural hospitals were less likely to do so than urban hospitals. Understanding where services are expanding in relation to community need may aid in successful policy interventions.
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