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Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States.

Abstract：

OBJECTIVE:To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR). PATIENTS AND METHODS:Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs). RESULTS:Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001). CONCLUSIONS:African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Alqahtani F,Aljohani S,Amin AH,Al-Hijji M,Ali OO,Holmes DR,Alkhouli M

doi

10.1016/j.mayocp.2017.11.026

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

607-617

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(17)30880-7

journal_volume

pub_type

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Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States.