Relationship between Patient Income Level and Mitral Valve Repair Utilization

  • Christina M. Vassileva
  • Theresa Boley
  • Joseph Standard
  • Stephen Markwell
  • Stephen Hazelrigg

Abstract

Background: The superiority of mitral valve (MV) repair is well established with respect to long-term survival, preservation of ventricular function, and valve-related complications. The relationship between patient income level and the selection of MV procedure (repair versus replacement) has not been studied.

Methods: The 2005 to 2007 Nationwide Inpatient Sample database was searched for patients ? 30 years old with MV repair or replacement; patients with ischemic and congenital MV disease were excluded. Patients were stratified into quartiles according to income level (quartile 1, lowest; quartile 4, highest). We used univariate and multivariate models to compare patients with respect to baseline characteristics, selection of MV procedure, and hospital mortality.

Results: The preoperative profiles of the income quartiles differed significantly, with more risk factors occurring in the lower income quartiles. Unadjusted hospital mortality decreased with increasing income quartile. The percentage of patients receiving MV repair increased with increasing income (35.6%, 39.6%, 48.2%, and 55.8% for quartiles 1, 2, 3, and 4, respectively; P = .0001). Following adjustment for age, race, sex, urban residency, admission status, primary payer, Charlson comorbidity index, and hospital location and teaching status, the income quartiles had similar hospital death rates, whereas the highly significant relationship between valve repair and income level persisted (P = .0008).

Conclusions: Significant disparity exists among patients in the different income quartiles with respect to the likelihood of receiving MV repair. MV repair is performed less frequently in patients with lower incomes, even after adjustment for differences in baseline characteristics. The higher unadjusted mortality rate for less affluent patients appears mostly related to their worse preoperative profiles.

References

Agabiti N, Cesaroni G, Picciotto S, et al. 2008. The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery. J Epidemiol Community Health 62:882-9.\nAlter DA, Naylor CD, Austin P, Tu JV. 1999. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 341:1359-67.\nBagger JP, Edwards MB, Taylor KM. 2008. Influence of socioeconomic status on survival after primary aortic or mitral valve replacement. Heart 94:182-5.\nBirkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD. 2008. Socioeconomic status and surgical mortality in the elderly. Med Care 46:893-9.\nBoscarino JA, Chang J. 1999. Survival after coronary artery bypass graft surgery and community socioeconomic status: clinical and research implications. Med Care 37:210-6.\nChang WC, Kaul P, Westerhout CM, Graham MM, Armstrong PW. 2007. Effects of socioeconomic status on mortality after acute myocardial infarction. Am J Med 120:33-9.\nCharlson ME, Pompei P, Ales KL, MacKenzie CR. 1987. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373-83.\nClark AM, Duncan AS, Trevoy JE, Heath S, Chan M. 2010. Healthy diet in Canadians of low socioeconomic status with coronary heart disease: not just a matter of knowledge and choice. Heart Lung 40:156-63.\nD'Hoore W, Bouckaert A, Tilquin C. 1996. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49:1429-33.\nDeyo RA, Cherkin DC, Ciol MA. 1992. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613-9.\nDuncan GJ, Daly MC, McDonough P, Williams DR. 2002. Optimal indicators of socioeconomic status for health research. Am J Public Health 92:1151-7.\nFreed LA, Levy D, Levine RA, et al. 1999. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 341:1-7.\nGillinov AM, Cosgrove DM 3rd. 2003. Current status of mitral valve repair. Am Heart Hosp J 1:47-54.\nGrossi EA, Galloway AC, Miller JS, et al. 1998. Valve repair versus replacement for mitral insufficiency: when is a mechanical valve still indicated? J Thorac Cardiovasc Surg 115:389-94; discussion 394-6.\nHardy D, Liu CC, Xia R, et al. 2009. Racial disparities and treatment trends in a large cohort of elderly black and white patients with nonsmall cell lung cancer. Cancer 115:2199-211.\nHCUP (Healthcare Cost and Utilization Project). 2010. Overview of the Nationwide Inpatient Sample (NIS). Available at: http://www.hcup-us.ahrq.gov/nisoverview.jsp\nHCUP quality control procedures. 2008. Available at: http://www.hcup-us.ahrq.gov/db/quality.pdf\nJones EC, Devereux RB, Roman MJ, et al. 2001. Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). Am J Cardiol 87:298-304.\nPerier P, Deloche A, Chauvaud S, et al. 1984. Comparative evaluation of mitral valve repair and replacement with Starr, Bjork, and porcine valve prostheses. Circulation 70(pt 2):I187-92.\nPhilbin EF, McCullough PA, DiSalvo TG, Dec GW, Jenkins PL, Weaver WD. 2000. Socioeconomic status is an important determinant of the use of invasive procedures after acute myocardial infarction in New York State. Circulation 102(suppl 3):III107-15.\nPilote L, Tu JV, Humphries K, et al. 2007. Socioeconomic status, access to health care, and outcomes after acute myocardial infarction in Canada's universal health care system. Med Care 45:638-46.\nSchermerhorn ML, Giles KA, Hamdan AD, Dalhberg SE, Hagberg R, Pomposelli F. 2008. Population-based outcomes of open descending thoracic aortic aneurysm repair. J Vasc Surg 48:821-7.\nSingh JP, Evans JC, Levy D, et al. 1999. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 83:897-902.\nVassileva CM, Boley T, Markwell S, Hazelrigg S. 2012. Impact of hospital annual mitral volume on mitral valve repair rates and mortality. J Heart Valve Dis 21:41-7.\nVassileva CM, Markwell S, Boley T, Hazelrigg S. 2011. Impact of race on mitral procedure selection and short-term outcomes of patients undergoing mitral valve surgery. Heart Surg Forum 14:E221-6.\nVassileva CM, Stelle LM, Markwell S, Boley T, Hazelrigg S. 2011. Sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery. Heart Surg Forum 14:E276-82.\nWenneker MB, Weissman JS, Epstein AM. 1990. The association of payer with utilization of cardiac procedures in Massachusetts. JAMA 264:1255-60.\n
Published
2015-04-03
How to Cite
Vassileva, C., Boley, T., Standard, J., Markwell, S., & Hazelrigg, S. (2015). Relationship between Patient Income Level and Mitral Valve Repair Utilization. The Heart Surgery Forum, 16(2), E89-E95. https://doi.org/10.1532/HSF98.20121105
Section
Articles