Abstract
Social vulnerability index (SVI) measures social factors that impact clinical outcomes for a county or census tract, particularly cardiovascular disease outcomes. Over the last decade, Transcatheter aortic valve replacement (TAVR) has improved clinical outcomes for patients with Aortic Stenosis (AS). However, despite data suggesting a strong relationship between SVI and cardiovascular diseases and procedures, it is currently unknown whether SVI is associated with the urgency of receiving TAVR in AS.
SVI is associated with urgency of TAVR in AS.
Using Optum's de-identified Clinformatics® Data Mart Database (CDM, which includes U.S. patients with commercial insurance or Medicare Advantage) 26,252 admissions for TAVR were recorded between January 2018 and March 2022. We included patients who met the following eligibility criteria: TAVR as primary cause of admission, a previous diagnosis of AS, 12 months of prior insurance enrollment, and consistent ZIP codes during the study. We classified patient hospital admissions as either urgent or non-urgent according to CDM claims codes. SVI was cross-referenced to patients using patient ZIP codes and stratified into SVI quintiles. Generalized linear mixed-effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient- and hospital-level covariates.
Among 6680 admissions eligible for final analysis, 567 (8.5%) were classified as urgent, with proportions similar across SVI quintiles (ranging from 7.0% in the lowest SVI quintile, to 9.7% in the highest quintile). After adjusting for patient- and hospital-level variables, there was no significant differences in the odds of urgent admission for TAVR based on the SVI quintiles (OR for the highest to lowest SVI quintile: 1.29, 95% CI 0.90 - 1.85).
Among commercially insured patients with AS who underwent TAVR in the CDM, social vulnerability index was not associated with the urgency of TAVR procedure. Future research should include investigating the relationship between SVI and urgency of TAVR for AS among patients with public insurance and no insurance.