Journal Article

Trends in the likelihood of receiving percutaneous coronary intervention in a low-volume hospital and disparities by sociodemographic communities

Krumholz, Harlan, Lindquist, Karla, Hsia, Renee Y., Wang, Christina

2023

Overview

Over the past two decades, percutaneous coronary intervention (PCI) capacity has increased while coronary artery disease has decreased, potentially lowering per-hospital PCI volumes, which is associated with less favorable patient outcomes. Trends in the likelihood of receiving PCI in a low-volume center have not been well-documented, and it is unknown whether certain socioeconomic factors are associated with a greater risk of PCI in a low-volume facility. Our study aims to determine the likelihood of being treated in a low-volume PCI center over time and if this likelihood differs by sociodemographic factors. We conducted a retrospective cohort study of 374,066 hospitalized patients in California receiving PCI from January 1, 2010, to December 31, 2018. Our primary outcome was the likelihood of PCI discharges at a low-volume hospital (<150 PCI/year), and secondary outcomes included whether this likelihood varied across different sociodemographic groups and across low-volume hospitals stratified by high or low ZIP code median income. The proportion of PCI discharges from low-volume hospitals increased from 5.4% to 11.0% over the study period. Patients of all sociodemographic groups considered were more likely to visit low-volume hospitals over time (P<0.001). Latinx patients were more likely to receive PCI at a low-volume hospital compared with non-Latinx White in 2010 with a 166% higher gap in 2018 (unadjusted proportions). The gaps in relative risk (RR) between Black, Latinx and Asian patients versus non-Latinx white increased over time, whereas the gap between private versus public/no insurance, and high versus low income decreased (interaction P<0.001). In low-income ZIP codes, patients with Medicaid were less likely to visit low-volume hospitals than patients with private insurance in 2010; however, this gap reversed and increased by 500% in 2018. Patients with low income were more likely to receive PCI at low-volume hospitals relative to patients with high income in all study years. The likelihood of receiving PCI at low-volume hospitals has increased across all race/ethnicity, insurance, and income groups over time; however, this increase has not occurred evenly across all sociodemographic groups.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Angioplasty / Care and treatment / Coronary artery disease / Coronary vessels / Demographic aspects / Engineering and Technology / Ethnicity / Government programs / Health care disparities / Health risks / Heart attacks / Heart diseases / Hospital patients / Hospitals / Hospitals, Low-Volume / Humans / Income / Insurance / Low income groups / Medicaid / Medicare / Medicine and Health Sciences / Minority & ethnic groups / Mortality / Patients / Percutaneous Coronary Intervention / Postal codes / Race / Regression analysis / Retrospective Studies / Social factors / Social Sciences / Sociodemographics / Socioeconomic factors / Socioeconomics / Statistics / Surgery, Experimental / Surgical research / Transluminal angioplasty / Trends / Underserved populations / United States / Variables / Veins & arteries