Differences in Utilization of Drug-Eluting Stents by Race and Payer

• Published in: The American journal of cardiology 2007-10, Vol.100 (8), p.1192-1198
• Main Authors: Hannan, Edward L., PhD, Racz, Michael, PhD, Walford, Gary, MD, Clark, Luther T., MD, Holmes, David R., MD, King, Spencer B., MD, Sharma, Samin, MD
• Format: Article
• Language: English
• Subjects: African Americans; African Americans - statistics & numerical data; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - economics; Angioplasty, Balloon, Coronary - utilization; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Stenosis - economics; Coronary Stenosis - ethnology; Coronary Stenosis - therapy; Databases, Factual; Drug Delivery Systems; Drug-Eluting Stents - economics; Drug-Eluting Stents - utilization; Female; Health Services Accessibility - economics; Health Services Accessibility - statistics & numerical data; Healthcare Disparities; Hospitalization; Humans; Insurance, Health - statistics & numerical data; Male; Medicaid - statistics & numerical data; Medical research; Medical sciences; Medicare - statistics & numerical data; Middle Aged; Minority Groups - statistics & numerical data; New York - epidemiology; Paclitaxel - administration & dosage; Platelet Aggregation Inhibitors - administration & dosage; Socioeconomic Factors; Stents; United States; Vulnerable Populations - ethnology; Vulnerable Populations - statistics & numerical data
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.05.039

Numerous disparities in access to health care by race and gender have been identified in the literature. This study examines differences in the use of drug-eluting stents (DES) versus bare-metal stents (BMS) by race, payer, and income level. Data from New York State’s Percutaneous Coronary Intervention Reporting System from July 2003 to December 2004 were used to examine use of DES (20,165 patients) relative to BMS (4,547 patients) by race, payer, and annual income level, controlling for a variety of patient and hospital characteristics. African-Americans were found to be less likely to receive DES than other races between July 2003 and March 2004 (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.50 to 0.65) and between April 2004 and December 2004 (adjusted OR 0.74, 95% CI 0.61 to 0.90). These disparities were reduced (respective adjusted ORs 0.67, 95% CI 0.58 to 0.77 and 0.81, 95% CI 0.66 to 0.91) when controlling for admitting hospital and hospital volume, but were still significant. Medicaid/self-pay patients, and patients living in zip codes with median annual incomes between $20,000 and $30,000 were also less likely to receive DES in the first time period (adjusted respective ORs 0.80, 95% CI 0.68 to 0.93) and 0.85, 95% CI 0.75 to 0.96). In conclusion, African-Americans and low income groups receive DES less frequently than their counterparts compared with BMS. This is related to the hospitals where they are admitted, but not entirely.