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Implementation of Intravascular Coronary Lithotripsy in the United States: Social Determinants of Health
Abdul Rasheed Bahar1, Yasemin Bahar1, Ali Rabib2
1Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Insights
Coronary lithotripsy use varies by patient demographics, with women, African Americans, and lower-income individuals less likely to receive this treatment. These disparities highlight the need for equitable access to advanced cardiovascular interventions.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Interventions
Background:
- Healthcare access disparities persist in cardiovascular interventions.
- Coronary lithotripsy, a novel treatment for calcified coronary lesions, exhibits variable utilization based on sociodemographic factors.
Purpose of the Study:
- To examine the impact of sex, race, income, and hospital characteristics on the utilization of coronary lithotripsy in the United States.
- To identify sociodemographic disparities in access to this advanced cardiovascular therapy.
Main Methods:
- Analysis of the 2021 Nationwide Inpatient Sample database.
- Identification of patients undergoing percutaneous coronary intervention (PCI) and lithotripsy using ICD-10 codes.
- Multivariable logistic regression and propensity score matching to assess the influence of sociodemographic factors, comorbidities, and hospital characteristics on lithotripsy use.
Main Results:
- Of 261,260 PCI patients, 0.38% received lithotripsy.
- Women, African Americans, and Medicaid patients showed significantly lower odds of receiving lithotripsy compared to men, White patients, and Medicare beneficiaries, respectively.
- Higher income quartiles and non-Southern regions were associated with increased odds of lithotripsy utilization.
Conclusions:
- Significant disparities in coronary lithotripsy utilization exist based on sex, race, insurance status, income, and geographic region.
- These findings underscore the necessity for targeted interventions to ensure equitable access to advanced cardiovascular treatments.
- Further investigation is warranted to address persistent inequities in treatment allocation, beyond potential differences in disease prevalence.
Background:
Disparities in health care access persist in cardiovascular interventions. Coronary lithotripsy, a novel treatment for calcified coronary lesions, shows variability in utilization by sociodemographic factors.
Objectives:
This study examines the impact of sex, race, income, and hospital characteristics on lithotripsy use in the United States.
Methods:
Using the 2021 Nationwide Inpatient Sample, patients undergoing percutaneous coronary intervention were identified. Lithotripsy was defined by the International Classification of Diseases-10th Revision codes. Multivariable logistic regression assessed the impact of sociodemographic factors, adjusting for comorbidities and hospital characteristics. Outcomes were compared using propensity score matching, with P < 0.05 considered significant.
Results:
Of 261,260 percutaneous coronary intervention patients, 1,000 (0.38%) underwent lithotripsy. Adjusted analyses revealed that women were less likely to receive lithotripsy than men (adjusted OR [aOR]: 0.65; 95% CI: 0.53-0.79; P < 0.001). African American patients had lower odds of receiving lithotripsy than Whites (aOR: 0.66; 95% CI: 0.48-0.93; P = 0.016). Medicaid patients were less likely to receive lithotripsy (aOR: 0.20; 95% CI: 0.11-0.36; P < 0.001) compared to Medicare beneficiaries. Higher-income quartiles increased odds of receiving lithotripsy compared to lower quartiles (aOR: 1.38-1.6; P < 0.05). Regional disparities were noted, with lower use in the South (aOR: 0.66; 95% CI: 0.47-0.94; P = 0.022).
Conclusions:
Disparities in lithotripsy utilization persist, driven by sex, race, insurance status, income, and geographic region. These findings emphasize the need for targeted interventions to promote equitable access to advanced cardiovascular therapies. While some disparities may reflect differences in disease prevalence, persistent inequities in treatment allocation warrant further investigation.
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