Association of Neighborhood Disparity on Access to Tissue Surgical Heart Valves

OBJECTIVES: Disadvantaged neighborhoods often have limited access to health-care resources and to the latest advances in health-care technology. For patients undergoing surgical heart valve replacement, tissue valve innovations are helping to increase durability without the need for life-long anticoagulation therapy as required for mechanical valves. This study estimates whether neighborhood disparity level is associated with lower access to tissue valves for surgical heart valve replacement.

METHODS: Healthcare Cost and Utilization Project (HCUP) state inpatient sample data were used to identify surgical aortic or mitral valve replacement (SAVR or SMVR) procedures in 2016 - 2019. For 18 states where patient zip codes were available, each zip code was assigned an Area Deprivation Index (ADI) ranking from 0 to 100 representing the level of neighborhood socioeconomic disadvantage. Unadjusted correlation analyses tested whether zip code ADI was associated with the percent of tissue valve usage. Correlations were run separately for SAVR and SMVR, and in total. Analyses were also replicated for the subset of patients aged 50 to 65 years generally recommended for either valve type per the ACC/AHA valvular heart disease guidelines.

RESULTS: Data from 63,075 SAVR and 24,419 SMVR patients were used to characterize ADI and tissue valve share for 8,636 zip codes. For patients of all ages, there was a significant negative correlation between ADI and valve type (p=0.0001 for total, SAVR, and SMVR). As level of area deprivation increased, less tissue valve replacement was performed: 84% tissue for low ADI (0-33), 81% for moderate ADI (34-67) and 79% for high ADI (68-100) zip codes. Similar results were found for patients aged 50-65, although the differences were smaller (total p<.0001, SAVR p=.0038, SMVR p=.0398).

CONCLUSIONS: Patients residing in high deprivation areas have significantly less access to the latest advances in tissue valves for aortic and mitral valve replacement.