Disparities in health and healthcare: Impact of race on resource utilization and costs following transcatheter edge-to-edge repair

• Authors: Sheriff N Dodoo, Northeast Georgia Medical Center; Alexis K Okoh, Emory University; Tanya Aggarwal, Northeast Georgia Medical Center; Abdul-Fatawu Osman, Michigan State University-Sparrow Hospital; Emmanuel Nkansah, Middle Tennessee State University; Abdullahi Oseni, Oklahoma College of Medicine; Oghenerukevwe Odiete, Peach-state Advance Cardiac and Endovascular (PACE) Center; Ugochukwu Egolum, Northeast Georgia Medical Center
• Journal Title: Cardiovascular Revascularization Medicine
• Volume: Volume 50
• Publisher: Elsevier | 2023-05-01, Pages 13-18
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.carrev.2023.01.005
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Transcatheter; Healthcare resource utilization; Disparity

Abstract

Background: This study sought to investigate health and healthcare disparities in the management of severe mitral regurgitation with transcatheter edge-to-edge repair using MitraClip and how racial differences impact resource utilization and costs. Methods: We retrospectively analyzed the National Inpatient Sample (NIS) for patients who underwent Transcatheter Edge-to-Edge Repair (TEER) using MitraClip between 2016 and 2018. The patients were stratified into four racial cohorts and study outcomes included high resource utilization (HRU), periprocedural complications, and total procedural costs. High resource utilization (HRU) was defined as length of stay (LOS) ≥7 days or a nonhome disposition at discharge. Multivariate logistic regression models were utilized to determine independent predictors of HRU. Results: 17,100 weighted TEER patients were segregated by race: Caucasian (n = 13,270), others (n = 1510), African Americans, AA (n = 1245) and Hispanics (n = 1075). More African Americans and Hispanics had TEER at Urban facilities (P < 0.001), which were teaching hospitals as well (P < 0.001) but were less likely to be covered by public insurance options -Medicare or Medicaid (P < 0.001). More AA (52.2 %) and Hispanics (27.6 %) were likely to be in the lowest median annual income quartile versus Caucasians (19.2 %) (P = 0.003). AA and Hispanics had higher resource utilization (HRU), prolonged length of stay, nonhome disposition at discharge, higher procedural costs and periprocedural complications versus Caucasians. The logistic regression model revealed acute kidney injury (AKI) and actual procedural costs as independent predictors of HRU in both African American and Hispanic groups. Conclusion: Significant Health and healthcare disparities do exist among underrepresented, racial minority patients undergoing transcatheter edge-to-edge repair in the US. These disparities were associated with higher resource utilization and actual costs in patients with mitral regurgitation treated with TEER.