Abstract 14818: Impact of Hospital and Socio-demographic Factors on Utilization of Drug-eluting Stents in Medicare Patients: Bringing Clarity to Disparity
Introduction: Studies perusing role of hospital & sociodemographic factors in disparities in drug eluting stent (DES) usage have shown insurance status to be a major predictor.
Hypothesis: Do hospital & sociodemographic factors impact DES utilization in patients with Medicare?
Methods: We linked data from the 2011 Medicare Inpatient Discharges (Top 100 DRGs), 2011 Medicare Hospital Referral Region (HRR) Report (to determine racial composition of each HRR) and American Hospital Association (to determine bedsize, location, ownership & teaching status). We analyzed stent DRG codes 249 (Bare Metal Stent without major complications or comorbidities [MCC]), 246 and 247 (DES with and without MCC respectively). HRRs were classified as African American (AA), Hispanic (H), White (W) and combined AA & H dominant areas. Using hospital zipcode household median income was determined from American Community Survey. Univariate & multivariate logistic regression were conducted to determine odds ratios for utilization of DES.
Results: 2011 Medicare cohort revealed 168,023 stent discharges (1436 hospitals/306 HRR) of which 80.5% were DES [DRG 246 (27,104), 247 (108,272) and 249 (32,647)]. Multivariate regression revealed higher odds of DES usage in H areas, median income>$20,000, urban and west region. Lower DES usage was seen in low volume and for-profit hospitals. (See Table 1&2)
Conclusion: While impact of hospital & sociodemographic factors on DES use is statistically significant in patients with medicare, disparity is less pronounced compared to prior studies in patients with different insurance. DES utilization was significantly higher in H areas and was similar in AA and W areas.
Author Disclosures: T.A. Tuliani: None. M.H. Shenoy: None. M. Parikh: None. D. Levine: None. M.G. Cohen: None. C. Grines: None. A. Hilliard: None.
- © 2014 by American Heart Association, Inc.