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CC BY-NC-ND 4.0 · Avicenna J Med 2017; 07(01): 17-22
DOI: 10.4103/2231-0770.197509
ORIGINAL ARTICLE

Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

Tushar A Tuliani
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
,
Maithili Shenoy
Department of Cardiology, University of Florida, Gainesville, Florida
,
Milind Parikh
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
,
Mauricio G Cohen
Department of Cardiology, University of Miami - Miller School of Medicine, Miami, Florida
,
Cindy Grines
Department of Cardiology, Wayne State University - Detroit Medical Center, Detroit, Michigan, USA
,
Kenneth Jutzy
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
,
Anthony Hilliard
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Objective: Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare). Methods: We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES. Results: There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33-1.42, P < 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥$20,001 (OR: 1.07, 95% CI: 1.01-1.13, P - 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63-0.69, P < 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85-0.92, P < 0.001). Conclusions: Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.

Keywords

Drug-eluting stent utilization - Medicare - sociodemographic factors


Publication History

Article published online:
09 August 2021

© 2017. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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