A retrospective cohort study has found the likelihood of receiving percutaneous coronary intervention (PCI) at low-volume hospitals has increased across all ethnicities, insurance and income groups over time, though this increase was not observed as occurring evenly across all sociodemographic groups.
The study authors have highlighted that their results persisted across all populations—even groups that are traditionally underserved—as well as patients with Medicare, Medicaid, private or no insurance, and across all income levels, providing “mixed results” when compared to their original hypothesis, the authors note.
Published in PLOS ONE in January of this year, researchers from University of California San Francisco and the Yale School of Medicine, analysed data from 374,066 patients hospitalised in California, who received PCI from 2010–2018. The team studied the trends across numerous patient demographics including race, ethnicity, insurance, and income to reveal differences in the likelihood of receiving PCI at a low-volume hospitals and in low- versus high-income communities.
Producing their “sobering” findings, Christina Wang (University of California San Francisco, San Francisco, USA), the study first author, and colleagues, reported that Black, Latinx, and Asian patients were more likely to receive PCI at low-volume hospitals compared with non-Latinx White patients. This gap increased across all racial groups in 2018, they state, noting the greatest change over time was between Latinx and non-Latinx White patients, where the gap was 166% higher in 2018 (2.4%) compared to 2010 (0.9%).
The investigators note that Medicaid beneficiaries were also more likely to end up at low-volume PCI hospitals respective to other insurance groups. High-income patients were also more likely, though these visits appeared to be most represented in low-volume PCI centres in high-income areas. Additionally, patients with high income were more likely to receive PCI at a low-volume hospital than patients with low-income. This trend was consistent in 2010 (7.8% versus 3.1%) and in 2018 (12.7% versus 10.8%, however, the gap decreased from 4.5% in 2010 to 1.9% in 2018.
“These results show that all patients receiving cardiac intervention, regardless of income and sociodemographic characteristics, are more likely to receive their care at a low-volume hospital today compared to a decade ago,” said Renee Hsia, (University of California San Francisco, San Francisco, USA), senior author of the study. “Our findings beg the question of whether the current incentives of how we provide healthcare services as a society is in the best interest of patients and whether we need to re-evaluate the status quo.”
When looking specifically at these likelihoods in low-income communities, the probability of PCI at a low-volume hospital was higher for low-income than for high-income patients and the observed differences across racial and ethnic groups were more pronounced.
Wang et al determine that their study helps elucidate the potential impact of the decreasing number of inpatient PCIs, increasing number of PCI-capable hospitals, and decreasing rates of myocardial infarction (MI) and coronary artery disease. Furthermore, they suggest their findings highlight the potential mechanism by which racial disparities in cardiovascular outcomes have been persistent.
“Our study’s findings make a case for ongoing policy research regarding equitable creation of new PCI-capable facilities as to not worsen existing disparities,” concludes Wang.
