Gender, race, and health insurance status in patients undergoing catheter ablation for atrial fibrillation

Nileshkumar Patel, Abhishek Deshmukh, Badal Thakkar, James O. Coffey, Kanishk Agnihotri, Achint Patel, Nitesh Ainani, Nikhil Nalluri, Nilay Patel, Nish Patel, Neil Patel, Apurva O. Badheka, Marcin Kowalski, Robert Hendel, Juan Viles-Gonzalez, Peter A. Noseworthy, Samuel Asirvatham, Kaming Lo, Robert J. Myerburg, Raul D. Mitrani

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p <0.001]), black (0.49 [95% CI 0.44 to 0.55; p <0.001]), and Hispanic race (0.64 [95% CI 0.56 to 0.72; p <0.001]) were associated with lower likelihoods of undergoing an AF ablation. Medicare (0.93, 0.88 to 0.98, <0.001) or Medicaid (0.67, 0.59 to 0.76, <0.001) coverage and uninsured patients (0.55, 0.49 to 0.62, <0.001) also had lower rates of AF ablation compared to patients with private insurance. In conclusion we found differences in utilization of catheter ablation for AF based on gender, race, and insurance status that persisted over time.

Original languageEnglish (US)
Pages (from-to)1117-1126
Number of pages10
JournalAmerican Journal of Cardiology
Volume117
Issue number7
DOIs
StatePublished - Apr 1 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Patel, N., Deshmukh, A., Thakkar, B., Coffey, J. O., Agnihotri, K., Patel, A., Ainani, N., Nalluri, N., Patel, N., Patel, N., Patel, N., Badheka, A. O., Kowalski, M., Hendel, R., Viles-Gonzalez, J., Noseworthy, P. A., Asirvatham, S., Lo, K., Myerburg, R. J., & Mitrani, R. D. (2016). Gender, race, and health insurance status in patients undergoing catheter ablation for atrial fibrillation. American Journal of Cardiology, 117(7), 1117-1126. https://doi.org/10.1016/j.amjcard.2016.01.040