OBJECTIVES: To explore how socioeconomic disadvantage ranking, measured by the Area Deprivation Index (ADI) impacts access to aortic valve procedures and the treatment of aortic valve disease, in comparison to other open and minimally invasive surgical procedures.

METHODS: The 2016-2019 Healthcare Cost and Utilization Project (state inpatient sample) data from 18 states was used: Arizona, Delaware, Florida, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wisconsin. This study employed the ADI, a multidimensional index of socioeconomic conditions at the zip code level. We estimated the relationship between ADI ranking and the difference in volume of Aortic Valve Replacement (AVR) and Transcatheter Aortic Valve Replacement (TAVR), versus Coronary Artery Bypass Graft (CABG) surgery and Laparoscopic Colectomy (LC). All regressions control for state and year fixed effects, population size, total number of hospitalizations, race, household income, median home value, labor force participation, unemployment rate, share of college educated, median family size, share married and median age.

RESULTS: Although the share of TAVR out of AVR procedures increased over time across zip codes, the increase is negatively correlated with ADI with high ADI areas lagging approximately one year behind low ADI areas. This is despite the higher share of hospitalizations per population in high ADI zip codes. Regression results show that there is a statistically significant and negative relationship between ADI and access to AVR (13.7% fewer AVRs in high ADI areas), TAVR (9.1% fewer TAVRs in high ADI areas), and LC (20% fewer LCs in high ADI areas), while no statistical difference in access to CABG, a common procedure.

CONCLUSIONS: People living in high ADI zip codes have less access to cutting edge life-saving technologies, such as AVR, and even more so to device-intensive minimally invasive procedures such as TAVR and LC.