Abstract 17112: Racial And Gender Disparities In Shift To Outpatient Revascularization Among Medicare Fee-for-service Beneficiaries

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A17112
• Main Authors: Savitz, Samuel, Falk, Kristine M, Stearns, Sally C, Fines, Jason, Grove, Lexie, Rossi, Joseph
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19-11-2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.17112

BackgroundThere has been a significant shift from inpatient to outpatient percutaneous coronary intervention (PCI) over the last decade. However, the shift to outpatient PCI may differ for patients based on non-clinical characteristics including race and gender. We evaluated the relative changes in the rate of inpatient and outpatient PCI procedures to determine if there were disparities by these groups.MethodsUsing fee-for-service (FFS) enrollees in the 20% Medicare sample, we identified all patients receiving PCI from 2007 to 2015. We excluded enrollees with Medicare Advantage or without Medicare Part D at the time of sample selection. Analyses focused on PCI procedure rates per 1,000 Medicare beneficiaries age 65 and older by race and gender groups. We calculated the rates by dividing the procedures by the exposure time for all FFS beneficiaries in the race and gender group. We calculated incident rate ratios (IRR) by comparing the rates in 2015 to the rates on 2007 to evaluate changes over time.ResultsDuring the study period, there was a significant decline in inpatient PCI and a significant increase in outpatient PCI among all groups (Table 1). The increase in outpatient PCI was greatest in magnitude for white men (IRR4.47), followed by white women (IRR3.97) compared to the other racial groups. Overall, the relative increase in outpatient PCI tended to be higher for men of all racial groups compared to women.ConclusionsAmong Medicare FFS beneficiaries, there has been a significant shift toward outpatient PCI. This shift was stronger for whites compared to other racial groups and for men compared to women, which suggests possible disparities in the treatment of coronary disease based on non-clinical factors such as race and gender.