A study by University of Pennsylvania researchers reveals a concerning trend in cardiac care access across socioeconomic lines. Patients in areas with higher socioeconomic disadvantage are less likely to receive advanced, less-invasive aortic valve replacement procedures compared to their counterparts in more privileged areas.
The study, led by LDI Senior Fellows Guy David and Alon Bergman, examined data from 18 states between 2016 and 2018. They focused on the distribution of coronary artery bypass grafting (CABG) and two types of aortic valve replacement: surgical (SAVR) and transcatheter (TAVR).
Results showed that patients in areas with higher deprivation scores had reduced access to both SAVR and TAVR. The disparity was particularly pronounced for TAVR, a less-invasive procedure that is now recommended by national guidelines for patients 80 years and older. In areas performing TAVR, volumes were, on average, 12% lower in locations with higher deprivation scores.
This inequity extends beyond cardiac procedures. The researchers found that laparoscopic colectomy, a minimally invasive method available for over two decades, was also less frequently performed in areas of higher deprivation. This suggests that the unequal distribution of advanced medical technologies persists over time.
The study raises questions about the impact of Medicare’s Coverage with Evidence Development policy, which restricts where TAVR can be performed. While intended to ensure patient safety, this policy may inadvertently reinforce healthcare inequities by not accounting for its disproportionate effect on different populations.
As the researchers continue to investigate the dispersion of medical technologies across various procedures, their findings underscore the urgent need to address systemic barriers in healthcare access. Ensuring equitable distribution of advanced medical innovations remains a critical challenge in the pursuit of health equity.
See: “Do Wealth and Poverty Affect Access to Less-Invasive Cardiac Surgery?” (March 13, 2024)