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Patel RV, Ravindran M, Qiu F, Manoragavan R, Sud M, Tam DY, Madan M, Marcus G, Elbaz‐Greener G, Mamas MA, Wijeysundera HC. Social Deprivation and Post-TAVR Outcomes in Ontario, Canada: A Population-Based Study. J Am Heart Assoc 2022; 12:e028144. [PMID: 36565194 PMCID: PMC9973610 DOI: 10.1161/jaha.122.028144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood-level social deprivation and post-TAVR mortality and hospital readmission. Methods and Results We conducted a population-based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co-primary outcomes were 1-year postprocedure mortality and 1-year postprocedure readmission. Using Cox proportional hazards models for mortality and cause-specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood-level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post-TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1-year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1-year readmission (hazard ratio, 1.23 [95% CI, 1.01-1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post-TAVR outcomes. Conclusions Residential instability was associated with increased risk for post-TAVR mortality, and the highest quintile of residential instability was associated with increased post-TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.
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Affiliation(s)
- Raumil V. Patel
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada
| | | | - Feng Qiu
- Institute for Clinical Evaluative SciencesOntarioTorontoCanada
| | - Ragavie Manoragavan
- Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Maneesh Sud
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Derrick Y. Tam
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Division of Cardiac Surgery, Department of SurgerySchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Mina Madan
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Gil Marcus
- Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
| | - Harindra C. Wijeysundera
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Institute for Clinical Evaluative SciencesOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada,Sunnybrook Research InstituteOntarioTorontoCanada
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