Impact of Hispanic Ethnicity, Geography, and Insurance Status on Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background: Hispanics are the largest and fastest growing ethnic minority population in the United States yet are poorly represented in cardiovascular outcomes studies. UC San Diego Health is a primary percutaneous coronary intervention (PCI) center for a diverse group of patients given its proximity to Mexico and underserved rural southeast Imperial County.

Objectives: The purpose of this study was to study the association between Hispanic ethnicity, geography, insurance status, and PCI outcomes.

Methods: The UC San Diego Health internal National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent PCI from January 2007 to September 2022. Complications and all-cause mortality within 1-year post-PCI were assessed.

Results: A total of 8,295 patients (age 66 years [IQR: 58-75 years], 72% male, 33% Hispanic ethnicity, and 30% from Imperial County) were included. Hispanics and patients from Imperial County irrespective of race or ethnicity had higher body mass index and were more likely to have diabetes, hypertension, hyperlipidemia, end-stage renal disease, and peripheral vascular disease. There was no difference in mortality rates between Hispanic and non-Hispanic Whites in the entire population. However, within Imperial County, Hispanics had significantly higher 30-day (1.4% vs 0.3% P = 0.02), 6-month (2.2% vs 0.8% P = 0.01), and 1-year (2.9% vs 0.9% P = 0.004) mortality rates compared to non-Hispanic Whites. Patients in Imperial County had lower 30-day (1.2% vs 1.9% P = 0.01), 6-month (1.9% vs 3.3% P < 0.001), and 1-year (2.4% vs 5% P < 0.001) mortality rates compared to patients outside of Imperial County. There was no difference in all-cause mortality rates by insurance status in non-Hispanic Whites. Uninsured Hispanic patients had a higher 30-day mortality rate compared to Hispanic patients who had Medicare/Medicaid or private insurance (4.5% vs 2.0% vs 1.0% P = 0.005). Within Imperial County, uninsured Hispanic patients had markedly higher 30-day mortality rate compared to Hispanic patients who had Medicare/Medicaid or private insurance (10.4% vs 1.6% vs 0.3% P < 0.001).

Conclusions: In socioeconomically disadvantaged areas, Hispanic patients had worse outcomes compared to non-Hispanic Whites compounded by uninsured status. There are complex demographic disparities in PCI outcomes for Hispanic patients and those residing in border zones which need to be recognized and mitigated.

Keywords: Hispanic ethnicity; percutaneous coronary intervention outcomes; racial and ethnic disparities.

Graphical abstract

Central Illustration

Post-PCI Mortality During 1-Year Follow-Up According to Hispanic Ethnicity and Geography (Left) Map depicting San Diego County and Imperial County in relation to Mexico and hospitals at which PCI procedures were performed. (Right) Time-to-first event curves for all-cause mortality post-PCI stratified by ethnicity and county of residence. NHW = non-Hispanic White; other abbreviation as in Figure 1.

Figure 1

CONSORT Diagram of Patients Included in the Study Flowchart of patients included in the study. CONSORT = Consolidated Standards of Reporting Trials; PCI = percutaneous coronary intervention.

Figure 2

Kaplan-Meier Curves Depicting All-Cause Mortality Post-PCI by Ethnicity, County of Residence, and Insurance Status Time-to-first event curves for (A) post-PCI all-cause mortality in Hispanic patients by insurance status and (B) post-PCI all-cause mortality in Hispanic patients in Imperial County by insurance status. Abbreviation as in Figure 1.