No-Transcatheter Aortic Valve Replacement (TAVR) Zones and Their Effect on Access to Care for Medicare Beneficiaries with Aortic Stenosis

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-02-13 DOI:10.1007/s12325-025-03116-8

Guy David, Andrew J. Epstein, Jay Giri, Ashwin Nathan, Soumya G. Chikermane, Michael Ryan, Christin Thompson, Seth Clancy, Candace Gunnarsson

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引用次数: 0

Abstract

Introduction

This study investigates the impact of geographic and socioeconomic barriers on access to transcatheter aortic valve replacement (TAVR).

Methods

Utilizing Medicare data from the US Centers for Medicare and Medicaid Services, this study analyzed TAVR and surgical aortic valve replacement (SAVR) procedures among beneficiaries from 2017 to 2022. Geographic units were defined by 5-digit zip codes, categorized on the basis of TAVR/SAVR volume into four categories: (1) no TAVR or SAVR, (2) no-TAVR zone (SAVR present, no TAVR), (3) low-TAVR zone (TAVR/SAVR ratio ≤ 0.5), and (4) TAVR accessible (TAVR/SAVR ratio > 0.5). The differential distance index (DDI) was developed to measure travel hurdles, calculated as the difference in miles from a patient’s zip code center to the treatment hospital (TAVR versus SAVR, CABG (coronary artery bypass grafting), and PCI (percutaneous coronary intervention) comparators). This study maintained a continuous access variable to model outcomes such as the ratio or volume of TAVR/SAVR and the percentage share of TAVR/AVR within each zip code over biennial periods (2017–2018, 2019–2020, 2021–2022). Covariates in the model included population density, area deprivation index (ADI), and calendar time, with an exploration of the interaction between DDI and ADI.

Results

The analysis revealed significant geographic disparities in TAVR access across the USA, with no-TAVR zone and low-TAVR zone areas often featuring lower population densities, higher ADIs, and more rural settings. Increased travel distance (DDI) significantly correlated with lower TAVR utilization, emphasizing distance as a critical barrier. Furthermore, both ADI and DDI emerged as significant predictors of TAVR volume and share, underlining the compound effect of socioeconomic status and geographic distance on healthcare access.

Conclusions

This study highlights the critical role of geographic and socioeconomic barriers in accessing advanced medical treatments like TAVR. Addressing these barriers may ensure equitable healthcare distribution, guiding policymakers and providers towards more accessible healthcare solutions for all populations.

查看原文本刊更多论文

无经导管主动脉瓣置换术（TAVR）区及其对主动脉狭窄医疗保险受益人获得护理的影响。

本研究调查了地理和社会经济障碍对经导管主动脉瓣置换术（TAVR）的影响。方法：利用美国医疗保险和医疗补助服务中心的医疗保险数据，本研究分析了2017年至2022年受益人的TAVR和外科主动脉瓣置换术（SAVR）手术。地理单元由5位邮政编码定义，根据TAVR/SAVR体积分为4类：(1)无TAVR或SAVR，(2)无TAVR区（SAVR存在，无TAVR），(3)低TAVR区（TAVR/SAVR比≤0.5），(4)TAVR可达（TAVR/SAVR比> 0.5）。差分距离指数（DDI）被用来测量旅行障碍，计算从病人的邮政编码中心到治疗医院的英里差（TAVR与SAVR， CABG（冠状动脉旁路移植术）和PCI（经皮冠状动脉介入治疗）比较）。本研究为模型结果保留了一个连续访问变量，如TAVR/SAVR的比率或体积，以及TAVR/AVR在每个邮政编码内的百分比份额，为期两年（2017-2018年、2019-2020年、2021-2022年）。模型的协变量包括人口密度、面积剥夺指数（ADI）和日历时间，并探讨了DDI和ADI之间的相互作用。结果：分析显示，TAVR在美国各地的使用存在显著的地理差异，无TAVR区和低TAVR区通常具有较低的人口密度、较高的adi和更多的农村环境。旅行距离的增加与TAVR利用率的降低显著相关，强调了距离是一个关键的障碍。此外，ADI和DDI都是TAVR数量和份额的重要预测因子，强调了社会经济地位和地理距离对医疗保健可及性的复合效应。结论：这项研究强调了地理和社会经济障碍在获得像TAVR这样的先进医学治疗方面的关键作用。解决这些障碍可以确保公平的医疗保健分配，指导决策者和提供者为所有人口提供更容易获得的医疗保健解决方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.