دورية أكاديمية
أعرض في EDS

Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.

التفاصيل البيبلوغرافية
العنوان: Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.
المؤلفون: Hyland PM; Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Xu J; Harvard Medical School, Boston, Massachusetts, USA.; Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA., Shen C; Harvard Medical School, Boston, Massachusetts, USA.; Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA., Markson LJ; Harvard Medical School, Boston, Massachusetts, USA.; Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Manning WJ; Harvard Medical School, Boston, Massachusetts, USA.; Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Strom JB; Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA jstrom@bidmc.harvard.edu.; Harvard Medical School, Boston, Massachusetts, USA.; Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts, USA.
المصدر: Heart (British Cardiac Society) [Heart] 2022 May 25; Vol. 108 (12), pp. 956-963. Date of Electronic Publication: 2022 May 25.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BMJ Pub. Group, c1996-
مواضيع طبية MeSH: Delivery of Health Care, Integrated* , Medicare*, Aged ; Echocardiography ; Female ; Healthcare Disparities ; Hispanic or Latino ; Humans ; Infant ; Male ; Racial Groups ; United States/epidemiology
مستخلص: 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, p<0.001), women (RR 0.97, 95% CI 0.95 to 0.99, p<0.001) and non-white individuals (RR 0.95, 95% CI 0.93 to 0.97, p<0.001). Black women in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 to 0.95, p<0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00 to 1.08, p=0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00 to 1.10, p=0.04).
Conclusions: 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.
Competing Interests: Competing interests: JBS reports additional grant support from Edwards Lifesciences, Ultromics and HeartSciences, consulting for Bracco Diagnostics, and speaker fees from Northwest Imaging Forums, unrelated to the submitted work. CS is an employee of Biogen.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
References: Am J Med. 2012 Oct;125(10):1000-9. (PMID: 22748404)
Hypertension. 2008 Apr;51(4):1149-55. (PMID: 18259013)
Circulation. 2019 Mar 5;139(10):e56-e528. (PMID: 30700139)
J Am Coll Cardiol. 2018 May 15;71(19):2122-2132. (PMID: 29535061)
Circulation. 2005 Mar 15;111(10):1225-32. (PMID: 15769762)
JACC Cardiovasc Interv. 2020 Jan 27;13(2):149-156. (PMID: 31973792)
Acad Emerg Med. 2010 Aug;17(8):801-8. (PMID: 20670316)
Heart Rhythm. 2009 Mar;6(3):325-31. (PMID: 19251206)
J Am Coll Cardiol. 2011 Jan 18;57(3):245-52. (PMID: 21232662)
JACC Cardiovasc Imaging. 2019 Apr;12(4):751-752. (PMID: 30121267)
Circulation. 2009 May 12;119(18):2463-70. (PMID: 19398667)
J Am Coll Cardiol. 2011 Mar 1;57(9):1126-66. (PMID: 21349406)
Health Care Financ Rev. 2004 Winter;26(2):61-72. (PMID: 25371985)
J Am Coll Cardiol. 2018 May 15;71(19):2133-2135. (PMID: 29747833)
N Engl J Med. 2009 Mar 19;360(12):1172-4. (PMID: 19297569)
معلومات مُعتمدة: K23 HL144907 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: delivery of health care; echocardiography; quality of health care
تواريخ الأحداث: Date Created: 20211007 Date Completed: 20220527 Latest Revision: 20220902
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC9432347
DOI: 10.1136/heartjnl-2021-319951
PMID: 34615667
قاعدة البيانات: MEDLINE
الوصف
تدمد:1468-201X
DOI:10.1136/heartjnl-2021-319951