Background:Despite the benefits of novel therapeutics, inequitable diffusion of new technologies may generate disparities. We examined the growth of transcatheter aortic valve replacement (TAVR) in the United States to understand the characteristics of hospitals that developed TAVR programs and the socioeconomic status of patients these hospitals served.Methods:We identified fee-for-service Medicare beneficiaries aged 66 years or older who underwent TAVR between January 1, 2012, and December 31, 2018, and hospitals that developed TAVR programs (defined as performing ≥10 TAVRs over the study period). We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between core-based statistical area level markers of socioeconomic status and TAVR rates.Results:Between 2012 and 2018, 583 hospitals developed new TAVR programs, including 572 (98.1%) in metropolitan areas, and 293 (50.3%) in metropolitan areas with preexisting TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated fewer patients with dual eligibility for Medicaid (difference of −2.83% [95% CI, −3.78% to −1.89%], P≤0.01), higher median household incomes (difference $2447 [95% CI, $1348–$3547], P=0.03), and from areas with lower distressed communities index scores (difference −4.02 units [95% CI, −5.43 to −2.61], P≤0.01). After adjusting for the age, clinical comorbidities, race and ethnicity and socioeconomic status, areas with TAVR programs had higher rates of TAVR and TAVR rates per 100 000 Medicare beneficiaries were higher in core-based statistical areas with fewer dual eligible patients, higher median income, and lower distressed communities index scores.Conclusions:During the initial growth phase of TAVR programs in the United States, hospitals serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.

中文翻译：

---

2012-2018 年建立经导管主动脉瓣置换计划的医院的社会经济和地理特征

背景：尽管新疗法有好处，但新技术的不公平传播可能会产生差异。我们检查了美国经导管主动脉瓣置换术 (TAVR) 的增长情况，以了解制定 TAVR 计划的医院的特点以及这些医院所服务患者的社会经济状况。方法：我们确定了 66 岁的按服务付费的医疗保险受益人在 2012 年 1 月 1 日至 2018 年 12 月 31 日期间接受 TAVR 的或年龄更大的患者，以及开发 TAVR 计划的医院（定义为在研究​​期间执行 ≥10 次 TAVR）。我们使用线性回归模型比较了在建立和未建立 TAVR 计划的医院接受治疗的患者的社会经济特征，并描述了基于核心的社会经济地位统计区域水平标记与 TAVR 率之间的关联。结果：2012 年至 2018 年，583 家医院开发了新的 TAVR 项目，其中 572 个（98.1%）在大都市地区，293 个（50.3%）在大都市地区已有 TAVR 项目。与未启动 TAVR 计划的医院相比，已启动 TAVR 计划的医院治疗的具有双重医疗补助资格的患者较少（差异为 -2.83% [95% CI，-3.78% 至 -1.89%]，3%）在已有 TAVR 项目的大都市地区。与未启动 TAVR 计划的医院相比，已启动 TAVR 计划的医院治疗的具有双重医疗补助资格的患者较少（差异为 -2.83% [95% CI，-3.78% 至 -1.89%]，3%）在已有 TAVR 项目的大都市地区。与未启动 TAVR 计划的医院相比，已启动 TAVR 计划的医院治疗的具有双重医疗补助资格的患者较少（差异为 -2.83% [95% CI，-3.78% 至 -1.89%]，P ≤0.01），较高的家庭收入中位数（差异 2447 美元 [95% CI，1348-3547 美元]，P = 0.03），以及来自贫困社区指数得分较低的地区（差异 -4.02 个单位 [95% CI，-5.43 到 - 2.61]，P≤0.01)。在对年龄、临床合并症、种族和民族以及社会经济地位进行调整后，TAVR 项目的地区的 TAVR 发生率更高，每 10 万医疗保险受益人的 TAVR 率在基于核心的统计区域更高，双重符合条件的患者更少，收入中位数更高，以及较低的贫困社区指数得分。结论：在美国 TAVR 项目的初始增长阶段，服务于较富裕患者的医院更有可能启动项目。这种增长模式导致 TAVR 分布不均，贫困社区的比率较低。