Relationship of neighbourhood social deprivation & ethnicity on access to transcatheter & surgical aortic valve replacement: a population-level study

Background — Wide geographical variation in access to TAVR and SAVR exists, however, the impact of socio-ethnic factors on the geographic variation of AS management in Ontario is unknown.

Methods — Neighborhood rates of AS admissions, as a proxy for AS burden, and downstream TAVR and SAVR referrals and procedures were estimated for the 76 sub-regions in Ontario, Canada. To determine if the socio-ethnic geographic variations in referrals and procedures were concordant or discordant with AS burden, Pearson correlation coefficients (R) were calculated to determine the relationship between AS burden and each of TAVR referrals, TAVR procedures, SAVR referrals, or SAVR procedures.Generalized linear models were developed to determine the association between social deprivation indices captured in the ON-MARG index, and the rates of AS burden as well as TAVR/SAVR referral and procedures.

Results — There was wide geographical variation that was concordant between AS burden and the referral and procedure rates for TAVR and SAVR (correlation coefficients 0.86-0.96). Increased dependency was associated with higher rates of both TAVR/SAVR referrals and procedures (rate ratios 1.63-2.22). Neighborhoods with a higher concentration of ethnic minorities were associated with lower AS burden as well as lower rates of both SAVR and TAVR referrals and procedures (rate ratios 0.57-0.85).

Conclusions — An important ethnic gradient exists in AS burden and in both referral and completion of TAVR and SAVR in Ontario. Further research is necessary to understand if this gradient is appropriate or requires mitigation.