Abstract 115: Gender Based Disparity in Transcatheter Aortic Valve Replacement Utilization: Insights from Nationwide Inpatient Sample 2012-2016

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has increasingly become the treatment of choice for symptomatic, severe aortic stenosis in patients at high surgical risk. While women have better morbidity & mortality outcomes following TAVR, it is unclear if there is gender disparity in utilization. We investigated gender-based utilization trends of TAVR and assessed associations with income quartiles & comorbidities. Methods: The Nationwide Inpatient Sample (NIS) data was queried from January 2012 to December 2016 to identify patients undergoing TAVR using International Classification of Diseases (ICD) procedural codes. Statistical analyses included baseline comparisons by gender, analyzing associations between gender, TAVR utilization, income & co-morbidities, with use of Chi-square test for categorical variables and Wilcoxon rank sum test for age. The associations were also analyzed using a propensity score matched subset & a logistic regression model. Results: We identified 21,859 TAVR patients (46.9% women, n=10,259). Women were older than men (median, IQR: 83, 77-87 vs 82, 76-87) and had higher prevalence of hypertension, diastolic heart failure, and pulmonary hypertension (p<0.001). Conversely diabetes, renal disease, atrial fibrillation, prior coronary angioplasty, and systolic heart failure were more prevalent in men (Table 1). TAVR utilization trend from 2012 to 2016 demonstrated a widening gap between the genders (p= 0.006) (Figure A). Median household income was associated with TAVR utilization in women in the entire cohort (p=0.028). However, in the propensity score matched subset, though heterogeniety was noted, the association was not significant per income quartile per year (Figure B). Combining data from all years, a multivariable logistic regression model confirmed that gender-based utilization did not associate with socio-economic factors such as income after adjustment for comorbidities. Conclusion: These findings showed widening utilization gap of TAVR between men and women, despite knowledge of better long-term outcomes in women. Economic factors were not associated with the gender disparity in TAVR utilization. Therefore, further research into TAVR registries is needed to analyze factors impacting this disparity and measures to correct it.