Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system
- 6 October 2021
- Vol. 108 (12), 956-963
- https://doi.org/10.1136/heartjnl-2021-319951
Abstract
Objective To identify potential race, sex and age disparities in performance of transthoracic echocardiography (TTE) over several decades. Methods TTE reports from five academic and community sites within a single integrated healthcare system were linked to 100% Medicare fee-for-service claims from 1 January 2005 to 31 December 2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilisation after the index TTE according to baseline age, sex, race and comorbidities among individuals with ≥2 TTEs. Non-white race was defined as black, Asian, North American Native, Hispanic or other categories using Medicare-assigned race categories. Results A total of 15 870 individuals (50.1% female, mean 72.2±12.7 years) underwent a total of 63 535 TTEs (range 2–55/person) over a median (IQR) follow-up time of 4.9 (2.4–8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43–1.33; range 0.12–26.76). TTE use was lower in older individuals (relative risk (RR) for 10-year increase in age, 0.91, 95% CI 0.89 to 0.92, pConclusions Among Medicare beneficiaries with multiple TTEs in a single large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year, although this varied widely. Adjusted for comorbidities, female sex, non-white race and advancing age were associated with decreased TTE utilisation.Keywords
Funding Information
- National, Heart, Lung, and Blood Institute (1K23HL144907)
This publication has 16 references indexed in Scilit:
- Age and Gender Differences in Quality of Care and Outcomes for Patients with ST-segment Elevation Myocardial InfarctionThe American Journal of Medicine, 2012
- ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest PhysiciansJournal of Invasive Cardiology, 2011
- The Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (credo): Why credo Matters to CardiologistsJournal of Invasive Cardiology, 2011
- Racial and Sex Differences in Emergency Department Triage Assessment and Test Ordering for Chest Pain, 1997–2006Academic Emergency Medicine, 2010
- Differences in Specialist Consultations for Cardiovascular Disease by Race, Ethnicity, Gender, Insurance Status, and Site of Primary CareJournal of the American College of Cardiology, 2009
- Ethnic and racial disparities in cardiac resynchronization therapyHeart Rhythm, 2009
- Eliminating Racial and Ethnic Disparities in Cardiac CareThe New England Journal of Medicine, 2009
- Gender Disparities in Blood Pressure Control and Cardiovascular Care in a National Sample of Ambulatory Care VisitsHypertension, 2008
- Racial Variations in Treatment and Outcomes of Black and White Patients With High-Risk Non–ST-Elevation Acute Coronary SyndromesJournal of the American College of Cardiology, 2005
- Accuracy and Bias of Race/Ethnicity Codes in the Medicare Enrollment Database2004