Background: Rates of receipt of left ventricular assist devices (LVADs) are less than expected for racial/ethnic minorities. A major etiology of this disparity changed over the past few years with broader access to insurance. Thus, we hypothesized that changes in the census-adjusted rate of receipt of LVADs would be higher for racial/ethnic minorities than Caucasians independent of sex and age.
Methods: Using the Interagency Registry of Mechanically Assisted Circulatory Support, we analyzed 10,795 patients (African-American 24.8%, Asian 1.5%, Caucasian 67.4%, Hispanic 6.3%, female 21.4%) who had an LVAD implanted between 2012-2015. Linear models were fit to annual census-adjusted rate of LVAD implantation, and the rate of change in receipt of LVADs was compared for each racial/ethnic minority to Caucasians, stratified by sex and age group.
Results: Between 2012 and 2015, African-Americans had an increase in the census-adjusted annual rate of receipt of LVADs per 100,000 [+0.26 (95% CI: 0.17-0.34)], while others exhibited no significant changes [Caucasian: +0.06 (95%CI: -0.03-0.14); Hispanic: +0.04 (95%CI: -0.05-0.12); Asian: +0.04 (95%CI: -0.04-0.13)]. When stratified by sex, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was present for both sexes [African-American women: +0.14 (95%CI: 0.01-0.27); African-American men: +0.28 (95%CI: 0.15-0.41)]. No increase was observed in either sex among other racial/ethnic groups (Figure 1a). When stratified by age group, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was limited to those aged 40-59 years [African-Americans aged: 20-39: +0.09 (95%CI: -0.20-0.39); 40-49: +0.41 (95%CI: 0.11-0.70); 50-59: +0.31 (95%CI: 0.01-0.60); 60-69: +0.22 (95%CI: -0.08-0.51); 70+: +0.07 (95%CI: -0.23-0.36)]. No differences by age group were observed among other racial/ethnic groups compared to Caucasians (Figure 1b).
Conclusions: From 2012-2015, rates of receipt of LVADs increased for African-Americans but not other racial/ethnic groups in comparison to Caucasians. Similar patterns were seen when stratified by sex. When stratified by age, the increase in rate was limited to middle-aged African-Americans.