Abstract 993: Trends in Racial Differences in the Use of Drug-Eluting Stents: Introduction and Diffusion
Background: Drug-eluting stents (DES) were used less frequently among black patients when first introduced in 2003. It is unclear whether racial differences persisted as DES diffused.
Methods: We used data from the 2003– 6 Nationwide Inpatient Sample, a multi-state sample of hospitalizations, to identify patients receiving bare metal stents or DES. Analysis was limited to patients age 18 years or older, of black or white race, treated at hospitals with 5 or more PCIs annually (N=374,589). Random-effects logistic regression assessed the independent association of race and DES adjusting for patient and hospital characteristics. Racial differences in DES were partitioned into those attributable to differences in treatment within hospitals (blacks treated differently than whites at the same hospital) and those attributable to differences between hospitals (blacks treated at different hospitals than whites).
Results: Blacks had lower crude rates of DES use than whites in Q2/03 (black-white difference −6.0% [95% CI −7.8% to −4.1%]). Racial differences persisted after multivariable adjustment (−3.7% [−5.6% to −1.8%]). Racial differences were found in treatment within hospital (−7.0% [−10.3% to −3.7%]), while patients treated at hospitals with higher shares of black patients had lower rates of DES (−6.0% [−10.2% to −1.9%] per 10% increase in share of black patients). Racial differences decreased over time and disappeared by Q4/04 (Figure⇓).
Conclusions: Racial differences in DES use reflected both disparate treatment of black patients within hospitals and black patients’ use of hospitals with lower DES use. Racial differences in DES use may have been caused by early DES scarcity.