Background The proportion of racial/ethnic minorities receiving ventricular assist devices (VADs) has previously been less than expected. It is unclear if trends have changed since the broadening of access to insurance in 2014 and the rapid adoption of VAD technology.

Methods and Results Using the Interagency Registry of Mechanically Assisted Circulatory Support, we analyzed time trends by race/ethnicity for 10 795 patients (white, 67.4%; African-American, 24.8%; Hispanic, 6.3%; Asian, 1.5%) who had a VAD implanted between 2012 and 2015. Linear models were fit to the annual census-adjusted rate of VAD implantation for each racial/ethnic group, stratified by sex and age group. From 2012 to 2015, African-Americans had an increase in the census-adjusted annual rate of VAD implantation per 100 000 (0.26 [95% confidence interval, 0.17–0.34]) while other ethnic groups exhibited no significant changes (white: 0.06 [−0.03 to 0.14]; Hispanic: 0.04 [−0.05 to 0.12]; Asian: 0.04 [−0.04 to 0.13]). Stratified by sex, rates increased in both African-American men and women (P<0.05), but the change in rate was highest among African-American men (men 0.37 [0.28–0.46]; women 0.16 [0.07–0.25]; interaction with sex P=0.004). Stratified by age group, rates increased in African-Americans aged 40 to 69 years and Asians aged 50 to 59 years (P<0.05). The observed differential change in VAD implantation rate by age group was significant among African-Americans (interaction with age, P<0.01) and Asians (interaction with age, P=0.02).

Conclusions From 2012 to 2015, VAD implantation rates increased among African-Americans but not other racial/ethnic groups. The greatest increase in rate was observed among middle-aged African-American men, suggesting a decline in racial disparities. Further investigation is warranted to reduce disparities among women and older racial/ethnic minorities.

背景技术以前接受心室辅助设备（VAD）的种族/族裔少数群体的比例低于预期。自2014年获得保险的机会扩大和VAD技术的快速采用以来，趋势是否已改变尚不清楚。

方法和结果使用机械辅助循环支持机构间注册表，我们按种族/民族分析了10 795名患者的种族/民族的时间趋势（白人，占67.4％；非裔美国人，占24.8％；西班牙裔，占6.3％；亚裔，占1.5％）。在2012年至2015年期间植入了VAD。线性模型适合每个种族/族裔群体的年度普查调整后的VAD植入率，并按性别和年龄组进行了分层。从2012年到2015年，非裔美国人的人口普查调整后的每10万年VAD植入率有所增加（0.26 [95％置信区间，0.17-0.34]），而其他族裔群体则没有显着变化（白人：0.06 [ -0.03至0.14]；西班牙裔：0.04 [-0.05至0.12]；亚洲人：0.04 [-0.04至0.13]）。按性别分层，非洲裔美国人男性和女性的发病率均上升（P<0.05），但非裔美国人男性的发病率变化最高（男性0.37 [0.28-0.46]；女性0.16 [0.07-0.25]；与性别的相互作用P = 0.004）。按年龄段分层，40至69岁的非洲裔美国人和50至59岁的亚洲人的发病率上升（P <0.05）。在非洲裔美国人（与年龄的交互作用，P <0.01）和亚洲人（与年龄的交互作用，P = 0.02）中，观察到的按年龄组划分的VAD植入率差异显着。

结论从2012年到2015年，非裔美国人的VAD植入率有所增加，但其他种族/族裔群体则没有增加。在中年非裔美国人中，发病率上升幅度最大，表明种族差异有所减少。有必要进行进一步调查，以减少妇女与年长的种族/族裔少数群体之间的差距。