Racial and income disparities persist in PCI among cardio-oncology patients despite comparable mortality: Propensity score nationally representative case-control analysis with machine learning augmentation of 30 million+ hospitalizations
Presenter
Jin wan Kim, MD, University of Texas Houston Health Science Center, Houston, TX
Jin wan Kim, MD1, Dominique J Monlezun, MD, PhD, PhD, MPH2, Nicolas Palaskas, MD2, Mehmet Cilingiroglu, MD, FSCAI3, Konstantinos Marmagkiolis, MD, MBA, FSCAI4 and Cezar A. Iliescu, MD, FSCAI2, (1)University of Texas Houston Health Science Center, Houston, TX, (2)Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Arkansas Heart Hospital, Little Rock, AR, (4)Premier Heart and Vascular Center, Zephyrhills, FL
Keywords: Acute Coronary Syndromes (ACS), Cardio-oncology, Coronary and Quality
Background:
Geographic disparities in income and race are unknown among cancer patients who undergo percutaneous coronary intervention (PCI).
Methods:
Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States’ largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Mortality regression models by PCI weighted by the complex survey design were fully adjusted for age, race, income, region, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI. Model optimization was conducted with forward and backward stepwise regression, standard regression diagnostics, and performance comparison to backward propagation neural network machine learning (ML) according to root mean squared error (RMSE).
Results:
Of 30,195,722 hospitalized adult patients, 15.43% had cancer, 3.84% underwent PCI, and most patients overall and specifically cancer patients who underwent PCI lived in the South Atlantic (FL, GA, MD, NC, SC, VA, WV: 22.15%) followed by East North Central regions (IN, IL, MI, OH, WI: 18.67%); mortality similarly was highest among cancer patients who underwent PCI in the above regions. Despite whites representing 76.3% of the 2016 population (US Census Bureau), 80.64% of the PCIs among cancer patients were performed in this group. As income quartiles increased, PCI frequency decreased among cancer patients. Multivariable regression found significant mortality disparities according to region (lowest in Mountain, East North Central, and South Atlantic), though there were no significant mortality disparities by income and region’s interaction or non-white race and region; similarly in the sub-group of cancer patients who underwent PCI, there were none according to region, the interaction of income and region, nor the interaction of non-white race and region. RMSE confirmed comparable model performance to ML analysis.
Conclusions:
This nationally representative analysis suggests that though there are racial, income, and regional disparities in PCIs being performed among cancer patients, equitable survival appears to be achieved across these groups.