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

Area of Science:

• Cardiology
• Health Services Research
• Health Equity

Background:

• Catheter ablation is an effective treatment for atrial fibrillation (AF).
• However, its utilization is resource-intensive and may not be universally accessible.
• Understanding disparities in access is crucial for equitable healthcare delivery.

Purpose of the Study:

• To investigate geographic, racial, ethnic, and socioeconomic disparities in catheter ablation utilization for AF.
• To identify factors contributing to inequities in AF ablation access.

Main Methods:

• Utilized Medicare fee-for-service data (2016-2019) for AF patients.
• Employed Generalized Estimating Equations to model associations between ZIP code characteristics and ablation rates.
• Examined ZIP code-level socioeconomic status (dual-eligibility) and racial/ethnic composition.

Main Results:

• Increased poverty (dual-eligibility) in a ZIP code correlated with significantly lower AF ablation rates (-275 per 10,000 per 10% increase).
• Higher percentages of Black patients in a ZIP code were associated with substantially fewer ablations (-618 per 10,000 per 10% increase).
• Higher percentages of Hispanic patients also showed reduced ablation rates (-430 per 10,000 per 10% increase).

Conclusions:

• Significant inequities exist in AF ablation utilization based on socioeconomic status, race, and ethnicity.
• These disparities in access for marginalized populations likely contribute to and worsen health inequities.
• Addressing these utilization gaps is essential for achieving health equity in cardiovascular care.