Abstract 14298: Socioeconomic Disparities in Blacks and Whites in Mini versus Standard Aortic Valve Replacements
OBJECTIVES: Although previous studies have examined the effects of race and socioeconomic status on cardiothoracic surgical outcomes, how these variables affect procedure allocation is incompletely understood. The goal of this study was to use geocoding to analyze the role of race and socioeconomic status for patients undergoing standard versus mini aortic valve replacement (AVR).
METHODS: A retrospective review of 896 isolated AVRs (2007-2012) was performed. Patients were geocoded by zip code and socioeconomic information was obtained from the U.S. Census Bureau. Patients were sub-classified by race and surgery type (standard vs. mini-AVR). Logistic regression, general linear modeling and Cox proportional hazards models were all used in this approach for dichotomous, numerical and survival time endpoints, respectively. Odds/hazard ratios and 95% confidence intervals were used to measure the strength of the associations.
RESULTS: A total of 141 BLACK and 755 WHITE patients underwent AVRs. For standard and mini-AVR within BLACK and WHITE patients, respectively, there was no difference in age, STS predicted risk of mortality (PROM), BMI, payer status, length of stay, and in-hospital mortality between surgical approach or race. When comparing race, BLACK standard AVR had increased LOS compared to WHITE standard AVR. BLACK patients living in neighborhoods with lower income (p<0.001), lower percent education (p=0.001), and higher percent poverty (p<0.001) were more likely to undergo standard AVR than mini-AVR. On the other hand, there was no difference in neighborhood income (p=0.79), education (p=0.75), and poverty (p=0.64) between WHITE patients undergoing mini-AVR vs. standard AVR.
CONCLUSIONS: There was no statistical advantage of mini vs standard AVR within races. However, BLACK patients living in neighborhoods with lower income, lower education, and higher percent poverty were more likely to receive standard AVR than mini-AVR.
- © 2013 by American Heart Association, Inc.