■经导管主动脉瓣植入(TAVI)率在黑人中低于白人个体。然而,目前还不清楚种族居住隔离,这在美国仍然很常见,有助于观察到的TAVI率差异。
■这项研究的目的是评估县级种族隔离之间的关联,和主动脉瓣狭窄(AS)诊断,管理,和结果。
■我们确定了黑人和白人医疗保险按服务付费的受益人年龄≥65岁,居住在美国大都市地区(2016-2019年)。使用美国社区调查的黑白住宅隔离指数,衡量地理种族分布,我们确定了每个受益人居住县的隔离。使用分层建模,我们确定了种族隔离与AS诊断率之间的关系,TAVI收据,和30天临床结果(死亡率,重新接纳,stroke).
■有29,264,075名受益人,其中22%的人生活在一个高隔离县。在黑人受益人中,与低隔离县居民相比,高隔离县居民的AS诊断率(OR:0.97;95%CI:0.96-0.98)和TAVI(OR:0.89;95%CI:0.86-0.93)降低.相比之下,在白人受益人中,高隔离县居民与较高的AS诊断率相关(OR:1.02;95%CI:1.02-1.03),TAVI无差异(OR:1.00;95%CI:0.99-1.00).隔离和种族与30天死亡率无关。
■在黑人医疗保险按服务收费的受益人中,生活在高隔离县与AS诊断率和TAVI率下降独立相关,白人受益人中没有看到的协会。居住的种族隔离可能会导致AS护理中的种族差异。
UNASSIGNED: Transcatheter aortic valve implantation (TAVI) rates are lower among Black compared with White individuals. However, it is unclear whether racial residential segregation, which remains common in the United States, contributes to observed disparities in TAVI rates.
UNASSIGNED: The purpose of this study was to evaluate the association between county-level racial segregation, and aortic stenosis (AS) diagnosis, management, and outcomes.
UNASSIGNED: We identified Black and White Medicare fee-for-service beneficiaries age ≥65 years living in metropolitan areas of the United States (2016-2019). Using the American Community Survey\'s Black-White residential segregation index, a measure of geographic racial distribution, we determined segregation in each beneficiary\'s county of residence. Using hierarchical modeling, we determined the association between racial segregation and rates of AS diagnosis, TAVI receipt, and 30-day clinical outcomes (mortality, readmission, stroke).
UNASSIGNED: There were 29,264,075 beneficiaries, of whom 22% lived in a high-segregation county. Among Black beneficiaries, high-segregation county residence was associated with decreased rates of AS diagnosis (OR: 0.97; 95% CI: 0.96-0.98) and TAVI (OR: 0.89; 95% CI: 0.86-0.93) compared with low-segregation county residence. In contrast, among White beneficiaries, high-segregation county residence was associated with higher rates of AS diagnosis (OR: 1.02; 95% CI: 1.02-1.03) and no differences in TAVI (OR: 1.00; 95% CI: 0.99-1.00). Segregation and race were not independently associated with 30-day mortality.
UNASSIGNED: Among Black Medicare fee-for-service beneficiaries, living in a high-segregation county was independently associated with decreased rates of AS diagnosis and TAVI, an association not seen among White beneficiaries. Residential racial segregation may contribute to racial disparities seen in AS care.