Trends in access disparities and equitable outcomes in intravascular lithotripsy: a 2021-2023 nationwide analysis

Early 2021 data showed significant disparities in intravascular lithotripsy (IVL) access, with women, Black patients, and Medicaid beneficiaries less likely to receive treatment. We evaluated whether disparities persisted during rapid national expansion and whether they were associated with differential clinical outcomes.

Using 2021-2023 National Inpatient Sample data, we examined access disparities among 267,598 percutaneous coronary intervention patients and clinical outcomes among 9824 IVL recipients. Multivariable logistic regression predicted IVL use and mortality, adjusting for demographics, comorbidities, and hospital characteristics. Due to Healthcare Cost and Utilization Project restrictions, race/regional analyses were limited to 2021-2022; sex and insurance analyses included all years.

IVL utilization increased from 0.55% in 2021 to 6.40% in 2023 (11.6-fold, P < 0.001). Females had 12% lower odds of receiving IVL (adjusted odds ratio [aOR] 0.88, 95% confidence interval [CI] 0.84-0.93), improved from the 35% gap in 2021. Race-based disparities were not statistically significant (Black aOR 0.93, 95% CI 0.80-1.08). Insurance disparities persisted with smaller effect sizes than earlier reports. Among IVL recipients, in-hospital mortality (4.2%) did not differ by sex, race, or insurance. Black patients experienced longer hospitalizations (8.2 vs 5.5 days; adjusted +2.2 days, P = 0.003).

Sex-based differences in IVL utilization narrowed substantially during the 11.6-fold expansion from 2021 to 2023, while race-based differences were no longer detectable within the study period. Insurance-related disparities persisted, although to a lesser extent. Comparable in-hospital mortality across demographic groups suggests that the remaining differences in access are more likely attributable to systemic barriers. The longer hospital length of stay observed among Black patients warrants further investigation into social determinants of health.