Inequities in Treatments and Outcomes Among Patients Hospitalized With Hypertrophic Cardiomyopathy in the United States

Abstract

Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies, sociodemographic factors have been associated with disparities in septal reduction therapy, but little is known about the association of sociodemographic factors with HCM treatments and outcomes more broadly. Methods and Results Using the National Inpatient Survey from 2012 to 2018, HCM diagnoses and procedures were identified by International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) codes. Logistic regression was used to determine the association of sociodemographic risk factors with HCM procedures and in‐hospital death, adjusting for clinical comorbidities and hospital characteristics. Of 53 117 patients hospitalized with HCM, 57.7% were women, 20.5% were Black individuals, 27.7% lived in the lowest zip income quartile, and 14.7% lived in rural areas. Among those with obstruction (45.2%), compared with White patients, Black patients were less likely to undergo septal myectomy (adjusted odds ratio [aOR], 0.52 [95% CI, 0.40–0.68]), or alcohol septal ablation (aOR, 0.60 [95% CI, 0.42–0.86]). Patients with Medicaid were less likely to undergo each procedure (aOR, 0.78 [95% CI, 0.61–0.99] for myectomy; aOR, 0.54 [95% CI, 0.36–0.83] for ablation). Women (aOR, 0.66 [95% CI, 0.58–0.74]), patients with Medicaid (aOR, 0.78 [95% CI, 0.65–0.93]), and patients from low‐income areas (aOR, 0.77 [95% CI, 0.65–0.93]) were less likely to receive implantable cardioverter‐defibrillators. Women (aOR, 1.23 [95% CI, 1.10–1.37]) and patients from towns (aOR, 1.16 [95% CI, 1.03–1.31]) or rural areas (aOR, 1.57 [95% CI, 1.30–1.89]) had higher odds of in‐hospital death. Conclusions Among 53 117 patients hospitalized with HCM, race, sex, social, and geographic risk factors were associated with disparities in HCM outcomes and treatment. Further research is required to identify and address the sources of these inequities.

Keywords

• disparities
• ethnicity
• hypertrophic cardiomyopathy
• outcomes
• race
• sex