Cardiac implantable electronic device deaths: A cross-sectional analysis of rural and urban disparities 1999–2020

• DOI: 10.1016/j.hroo.2024.03.002
• Publication Date: 2024-03-15T17:53:00Z
• Authors: Hoang Nhat; Ramzi Ibrahim; Enkhtsogt Sainbayar; Min Choon Tan; João Paulo Ferreira; Mohanad Elchouemi; Carola Gianni; Amin Al-Ahmad; Justin Z. Lee
• Keywords: Cross-sectional study

There has been an increase in implantation of cardiac implantable electronic devices (CIEDs) recent years. The incidence adverse events associated with these procedures are expected to increase. implications developments particularly concerning rural areas the United States (US), where public health challenges frequent and access specialized medical providers is limited [1Cyr M.E. et al.Access specialty healthcare urban versus US populations: a systematic literature review.BMC Health Serv Res. 2019; 19: 974Crossref PubMed Scopus (116) Google Scholar]. Our study aimed evaluate disparities related CIED mortality from 1999 2020. We extracted data Centers for Disease Control Prevention (CDC) Wide-ranging Online Data Epidemiologic Research database spanning years 2020 [2Center National Center Statistics. CDC wonder: multiple cause death 1999–2018. Prevention. .Google identified all decedents International Classification Diseases, 10th Revision (ICD10) code T82.1 (mechanical complication device) within cause-of-death records, which covers mechanical complications implantations such as obstruction, breakdown, leakage, malposition, displacement, protrusion, or perforation. These deaths were classified into categories based on 2013 Statistics criteria. collected demographic details included deaths, including age, sex, race, census region, certificates. To adjust counts we utilized direct method year 2000 standard population. This allowed us calculate compare age-adjusted rates (AAMR) per 1,000,000 population between areas, both cumulatively across groups. Rate ratios (RR) calculated by dividing AAMR that deaths. Using Delta method, 95% confidence intervals initially estimated natural log scale RRs then established exponentiating lower upper bounds CI. Institutional Review Board was not required given use government-issued publicly available data. adhered Strengthening Reporting Observational studies Epidemiology (STROBE) guidelines. total 419 regions 1,129 regions. higher among (AAMR 0.31 [95% CI, 0.28-0.34]) compared (0.18 0.17-0.20]) (Table 1). Among individuals < 65 years, similar 0.05 0.03-0.06]) 0.03 0.02-0.03]) Conversely, adults ≥ 2.16 1.93-2.38]) 1.28 1.20-0.37]).Table 1Cardiac Implantable Electronic Device Related Death. Table depicts counts, corresponding size, cumulative groups.PopulationRuralUrbanDeath CountPopulation SizeAAMR (95% CI)Death CountPopulationSizeAAMR CI)RR CI)All4191,006,871,6520.31 (0.28-0.34)1,1295,739,475,6490.18 (0.17-0.20)1.72 (1.54-1.93)Age< years55838,893,1050.05 (0.03-0.06)1724,978,979,0010.03 (0.02-0.03)1.67 (1.23-2.26)≥ years364167,978,5472.16 (1.93-2.38)957760,496,6481.28 (1.20-1.37)1.69 (1.50-1.90)SexMales210502,292,4000.40 (0.34 - 0.46)5342,815,055,4900.22 (0.20 0.24)1.82 (1.55-2.13)Females209504,579,2520.26 (0.23 0.30)5952,924,420,1590.16 (0.15 0.17)1.63 (1.39-1.90)RaceBlack2188,267,9940.28 (0.17 0.42)137830,766,8510.21 0.24)1.33 (0.84-2.11)White393881,053,1530.31 (0.28 0.35)9704,485,984,6570.17 (0.16 0.19)1.82 (1.62-2.05)US Census RegionNortheast47101,993,5850.34 (0.25 0.46)2511,111,001,3370.18 0.20)1.89 (1.38-2.58)Midwest145333,404,5720.29 (0.24 0.34)2481,132,716,6420.20 0.22)1.45 (1.18-1.78)South163429,500,2940.30 0.35)3952,068,317,7870.19 0.21)1.58 (1.32-1.90)West64141,973,2010.37 (0.29 0.48)2351,427,439,8830.17 (0.14 0.19)2.18 (1.65-2.87)*Rate = AAMRs urban.*Abbreviations: AAMR=age-adjusted rate, CIED=cardiac device, CI=confidence interval, RR=rate ratio, US=United States. Open table new tab *Rate urban. *Abbreviations: Within regions, male (0.40 0.34-0.46]) female (0.26 0.23-0.30]) had their (0.22 0.20-0.24]) 0.15-0.17]) decedent counterparts Black populations disproportionately impacted 0.28 0.17-0.42]) 0.21 0.17-0.24]). Similarly, White 0.28-0.35]) 0.17 0.16-0.19]). Northeastern 0.34 0.25-0.46]) 0.18 0.15-0.20]). along other (Midwest 0.29 0.24-0.34], South 0.30 0.25-0.35], West 0.37 0.29-0.48]) same 0.20 0.17-0.22], 0.19 0.17-0.21], 0.14-0.19]). rural-urban outcome disparity likely be multifactorial, operator characteristics barriers. shortage specialists led increased reliance general cardiologists perform procedures, increasing risk procedural [3Curtis J.P. al.Association physician certification outcomes patients receiving cardioverter-defibrillator.Jama. 2009; 301: 1661-1670Crossref (155) Higher prevalence tertiary hospitals advanced facility equipment also contributes procedure-related resource-limited Greater annual procedure volume less after [4Freeman J.V. al.The relation hospital cardioverter-defibrillator registry.Journal American College Cardiology. 2010; 56: 1133-1139Crossref (67) Furthermore, healthcare, poor literacy, poverty may lead missed post-procedure follow-up delayed management [5Chen X. al.Differences Rural Urban Information Access Use.J Health. 35: 405-417Crossref (154) Finally, our analysis showed no significant variance settings. finding suggests possible uniformity resources populations, irrespective urbanization status [6Wallace J. al.Disparities Care Spending Utilization Medicaid Enrollees.JAMA Forum. 2022; 3: e221398Crossref (8) limitations study. includes misclassification errors ICD-10 codes, undifferentiated reporting types, absence individual-level data, constrained ability account residual confounding. Additionally, potential ecological fallacy must acknowledged, it constrains extent findings can applied patient-level. did time elapsed occurrence death. Despite limitations, strengthened utilization database, nationally representative sample. results revealed US. warrant further investigation socioeconomic factors contribute this inequity.