Racial disparity and technology diffusion: the case of cardioverter defibrillator implants, 1996-2001

Abstract

Background: Although implantable cardioverter defibrillator (ICD) therapy is widely endorsed for preventing sudden cardiac death (SCD), prior research documented a large black-white disparity in ICD therapy among the elderly. No studies have examined this disparity among nonelderly adults or over time as ICD therapy became widely diffused.

Objective: This study compares disparity in use of ICD therapy for 1996-1998 to 1999-2001 between African Americans and other adults.

Methods: The National Hospital Discharge Survey is used to compare ICD utilization between black and other adults diagnosed with ventricular tachycardia, ventricular fibrillation or cardiac arrest.

Results: Adjusting for patient and hospital characteristics, ICD use per 100 at-risk patients rose from 11.0 to 27.3 among African Americans and from 24.0 to 37.5 among other adults between 1996-1998 and 1999-2001. Although the disparity was evident throughout the study period, it declined by 40%. Compared with their nonblack counterparts, black adults at risk for SCD were five years younger on average (p < 0.01) and more likely to be female (p < 0.01).

Conclusions: As ICD therapy became more widely available, use of this technology increased faster for black versus other adults, and the disparity in use declined but was not eliminated. Policymakers and clinicians should focus on increasing access among underserved populations to promising new technologies. Research focusing only on the elderly may miss important racial disparities when there is a race difference in the age distribution of disease risk. Further research should explore the relationship of technology diffusion to disparities in health service use.