Abstract 149: Disparities In Utilization Of Drug-eluting Stents By Payer Across Racial Groups

Background: Payer and race differences in utilization of drug-eluting stents (DES) have been reported, but the interaction between payer and race has not been well studied. Objectives: To examine if the impact of payer on utilization of DES is dependent on race. Methods and Results: A total of 77,142 stenting procedures performed between July 2006 and December 2007 were identified from the California’s hospital discharge database. Compared to private insurance, Medicaid, Medicare, and self-pay were associated with lower likelihood of receiving DES, the respective adjusted odds ratios (ORs) for receiving DES instead of bare-metal stents were 0.71 (95% confidence interval (CI): 0.66-0.77, P<0.0001), 0.82 (95% CI: 0.78-0.87, P<0.0001), and 0.46 (95% CI: 0.41-0.51, P<0.0001), controlling for patient characteristics including race/ethnicity. The adjusted ORs for Medicaid in comparison to private insurance ranged from 0.56 (P<0.001) in black to 0.74 (P=0.01) in Asian patients; the adjusted ORs for Medicare in comparison to private insurance ranged from 0.68 (P<0.001) in black to 0.97 (P=0.69) in Asian patients; and the adjusted ORs for self-pay in comparison to private insurance ranged from 0.35 (P<0.001) in black to 0.50 (P<0.001) in white patients. Conclusions: The disparities in utilization of DES by payer are in general consistent across race/ethnicity groups.