Race, sex, age disparities exist in TTE usage
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In a cohort of Medicare beneficiaries who received transthoracic echocardiography, usage of the modality was decreased among female, “non-white” and older individuals, according to recent results.
“Notably, these findings were most prominent among Black women and persisted despite adjusting for the competing risk of mortality,” Patrick M. Hyland, MD, cardiovascular medicine fellow at Beth Israel Deaconess Medical Center, and colleagues wrote.
For the study, Hyland and colleagues aimed to determine potential race, sex and age disparities with the use of transthoracic echocardiography (TTE) during a period of several decades. They linked TTE reports from five academic and community sites within a single integrated health care system to 100% Medicare fee-for-service claims from 2005 to 2017.
Hyland and colleagues performed multivariable Poisson regression analysis to determine adjusted rates of TTE utilization after the index TTE, according to baseline age, sex, race and comorbidities in individuals with at least two TTEs. Using Medicare-assigned race categories, researchers defined “non-white” as Black, Asian, North American Native, Hispanic or other categories.
During follow-up (median, 4.9 years), 15,870 individuals (50% women; mean age, 72 years) underwent 63,535 TTEs.
After index TTE, median TTE use was 0.72 TTEs per person per year. Usage of TTE was decreased among older individuals (RR for 10-year increase in age, 0.91; 95% CI, 0.89-0.92; P < .001), women (RR = 0.97; 95% CI, 0.95-0.99; P < .001) and “non-white” individuals (RR = 0.95; 95% CI, 0.93-0.97; P < .001). Furthermore, use of the modality was lowest among Black women (RR = 0.92; 95% CI, 0.88-0.95; P < .001).
In other data, HF (RR = 1.04; 95% CI, 1-1.08; P = .04) and chronic obstructive pulmonary disease (RR = 1.05; 95% CI, 1-1.1; P = .04) were the only clinical conditions yielding increased use of TTE after multivariable adjustment.
“These findings suggest the existence of significant age, racial and sex disparities in the receipt of TTE, which mirror the results observed in other disease subgroups and populations,” Hyland and colleagues wrote.
According to the researchers, underdiagnosis of valvular heart disease may be one contributing factor to the observed disparities.
“As appropriate use criteria for TTE have been published, developing mechanisms to promote adherence to these criteria may minimize gaps in TTE referral,” the researchers wrote. “The use of clinical decision support systems, such as a reminder system for patients who meet the established criteria for TTE, is one possible mechanism for closing the gap.”
They added, “Confirmatory studies are needed to assess the impact of these disparities on downstream utilization and health outcomes.”
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