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. 2024 Feb 28;14(1):4952.
doi: 10.1038/s41598-024-52660-w.

Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis

Chirag Ram #  1   2 , Sameh Yousef #  1 , Wei-Guo Ma  1 , Ishani Vallabhajosyula  1 , Saket Singh  1 , Ritu Agarwal  3 , Rita K Milewski  1 , Roland Assi  1 , Prakash A Patel  4 , Matthew Williams  1 , Arnar Geirsson  1 , Prashanth Vallabhajosyula  5
Affiliations

Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis

Chirag Ram et al. Sci Rep. .

Abstract

To investigate the association between area deprivation index (ADI) and aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). Patients aged 40-95 years with severe AS confirmed by echocardiography were included. The 9-digit zip code of patient residence address was used to identify the ADI ranking, based on which patients were divided into 5 groups (with Group E being most deprived). The rates of AV intervention were compared among 5 groups using competing risks analysis, with death as a competing event. We included 1751 patients with severe AS from 2013 to 2018 followed for a median 2.8 (interquartile range, 1.5-4.8) years. The more distressed ADI groups tended to be younger (P = 0.002), female (P < 0.001), and of African American race (P < 0.001), have higher presentation of sepsis (P = 0.031), arrhythmia (P = 0.022), less likely to have previous diagnosis of AS (P < 0.001); and were less likely to undergo AVR (52.5% vs 46.9% vs 46.1% vs 48.9% vs 39.7%, P = 0.023). Using competing risk analysis, the highest ADI group (E) were the least and the lowest ADI group (A) the most likely to undergo AVR (Gray's test, P = 0.025). The association between ADI ranking and AVR rates was influenced by sex and race. Within group analysis, there was significant association between race and AVR (Gray's test, P < 0.001), and between sex and AVR (Gray's test, P < 0.001). Patients with severe AS living in more deprived neighborhoods were less likely to undergo aortic valve interventions, which was influenced by female gender, and African American race.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Diagram displaying patient inclusion and the cohort of study.
Figure 2
Figure 2
Competing risks analysis shows that the rates of undergoing aortic valve replacement for severe aortic stenosis differed significantly among patients of 5 groups of area deprivation index (ADI) rankings, which was highest in Group A and lowest in Group E.
Figure 3
Figure 3
Group analysis showed significant association between race and aortic valve intervention.
Figure 4
Figure 4
Group analysis showed significant association between sex and aortic valve intervention.
See this image and copyright information in PMC

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