Enduring inequalities: Revascularization before and after the ACA

The use of revascularization (coronary artery bypass surgery [CABG] and percutaneous coronary intervention [PCI]) in the United States is declining, but they remain important procedures for the treatment of patients with coronary artery disease. There are large and long‐standing disparities in the use of revascularization among patients hospitalized with heart disease. In this article, we investigate whether the implementation of the Patient Protection and Affordable Care Act (ACA) is associated with a reduction in disparities in the use of revascularization. We use data from the Agency for Healthcare Research and Quality (AHRQ)'s National Inpatient Sample (NIP) of the Healthcare Cost and Utilization Project (HCUP) project to compare the use of revascularization among patients 45 years and older in the United States in 2012 and 2018. For both years, we conducted multiple logistic regression analysis to assess the factors associated with coronary revascularization among patients hospitalized with heart disease. Hospitalizations for heart disease and the use of revascularization both fell between 2012 and 2018 at a rate that was greater than the reduction in heart disease deaths in the country. These findings are consistent with the clinical literature on the growth of medical management of heart disease. Disparities in the use of revascularization, by gender, insurance status, neighborhood, and race/ethnicity, were just as large after the implementation of the ACA in 2014. The expansion of insurance by the ACA, alone, was insufficient to reduce disparities in the use of revascularization in patients with diagnosed coronary heart disease in the United States. 在美国，血运重建（冠状动脉搭桥手术(CABG)和经皮冠状动脉介入治疗(PCI)）的使用正在减少，但它们仍然是治疗冠状动脉疾病患者的重要程序。住院心脏病患者在血运重建方面的使用存在巨大且长期的差异。本文中，我们调查了患者保护与《平价医疗法案》(ACA)的实施是否与血运重建使用差异的减少有关。我们利用美国医疗保健研究与质量局(AHRQ)的医疗保健成本与利用项目(HCUP)全国住院患者样本(NIP)的数据，比较了2012年和2018年美国45岁及以上患者的血运重建使用情况。我们对这两年进行了多元逻辑回归分析，以评估心脏病住院患者冠状动脉血运重建的相关因素。2012年至2018年间，心脏病住院率和血运重建使用率均下降，且下降速度高于全国心脏病死亡人数的下降速度。这些发现与关于心脏病医疗管理增长的临床文献相一致。2014年《平价医疗法案》实施后，不同性别、保险状况、社区、种族/民族的血运重建使用差异同样巨大。仅凭《平价医疗法案》保险范围的扩大，不足以减少美国确诊冠心病患者的血运重建使用差异。 El uso de la revascularización (cirugía de revascularización coronaria (CABG) e intervención coronaria percutánea (PCI)) en los EE. UU. está disminuyendo, pero siguen siendo procedimientos importantes para el tratamiento de pacientes con enfermedad de las arterias coronarias. Existen grandes y duraderas disparidades en el uso de la revascularización entre paciente