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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2007 Mar;99(3):201–207.

Racial disparity and technology diffusion: the case of cardioverter defibrillator implants, 1996-2001.

Ava Stanley 1, Derek DeLia 1, Joel C Cantor 1
PMCID: PMC2569614  PMID: 17393943

Abstract

BACKGROUND: Although implantable cardioverter defibrillator (ICD) therapy is widely endorsed for preventing sudden cardiac death (SCD), prior research documented a large black-white disparity in ICD therapy among the elderly. No studies have examined this disparity among nonelderly adults or over time as ICD therapy became widely diffused. OBJECTIVE: This study compares disparity in use of ICD therapy for 1996-1998 to 1999-2001 between African Americans and other adults. METHODS: The National Hospital Discharge Survey is used to compare ICD utilization between black and other adults diagnosed with ventricular tachycardia, ventricular fibrillation or cardiac arrest. RESULTS: Adjusting for patient and hospital characteristics, ICD use per 100 at-risk patients rose from 11.0 to 27.3 among African Americans and from 24.0 to 37.5 among other adults between 1996-1998 and 1999-2001. Although the disparity was evident throughout the study period, it declined by 40%. Compared with their nonblack counterparts, black adults at risk for SCD were five years younger on average (p < 0.01) and more likely to be female (p < 0.01). CONCLUSIONS: As ICD therapy became more widely available, use of this technology increased faster for black versus other adults, and the disparity in use declined but was not eliminated. Policymakers and clinicians should focus on increasing access among underserved populations to promising new technologies. Research focusing only on the elderly may miss important racial disparities when there is a race difference in the age distribution of disease risk. Further research should explore the relationship of technology diffusion to disparities in health service use.

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Selected References

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  1. Alexander Mark, Baker Laurence, Clark Cheryl, McDonald Kathryn M., Rowell Richard, Saynina Olga, Hlatky Mark A. Management of ventricular arrhythmias in diverse populations in California. Am Heart J. 2002 Sep;144(3):431–439. doi: 10.1067/mhj.2002.125500. [DOI] [PubMed] [Google Scholar]
  2. Blustein J., Weitzman B. C. Access to hospitals with high-technology cardiac services: how is race important? Am J Public Health. 1995 Mar;85(3):345–351. doi: 10.2105/ajph.85.3.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Centers for Disease Control and Prevention (CDC) State-specific mortality from sudden cardiac death--United States, 1999. MMWR Morb Mortal Wkly Rep. 2002 Feb 15;51(6):123–126. [PubMed] [Google Scholar]
  4. Crystal S., Sambamoorthi U., Merzel C. The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts. Health Serv Res. 1995 Oct;30(4):593–614. [PMC free article] [PubMed] [Google Scholar]
  5. Dennison C., Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1. 2000 Dec;(39):1–42. [PubMed] [Google Scholar]
  6. Epstein A. E., Miles W. M., Benditt D. G., Camm A. J., Darling E. J., Friedman P. L., Garson A., Jr, Harvey J. C., Kidwell G. A., Klein G. J. Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations. A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Sep 1;94(5):1147–1166. doi: 10.1161/01.cir.94.5.1147. [DOI] [PubMed] [Google Scholar]
  7. Exner D. V., Klein G. J., Prystowsky E. N. Primary prevention of sudden death with implantable defibrillator therapy in patients with cardiac disease: Can we afford to do it? (Can we afford not to?). Circulation. 2001 Sep 25;104(13):1564–1570. doi: 10.1161/hc3801.096395. [DOI] [PubMed] [Google Scholar]
  8. Ferris Timothy G., Kuhlthau Karen, Ausiello John, Perrin James, Kahn Robert. Are minority children the last to benefit from a new technology? Technology diffusion and inhaled corticosteriods for asthma. Med Care. 2006 Jan;44(1):81–86. doi: 10.1097/01.mlr.0000188914.47033.cd. [DOI] [PubMed] [Google Scholar]
  9. Gillum R. F. Sudden cardiac death in Hispanic Americans and African Americans. Am J Public Health. 1997 Sep;87(9):1461–1466. doi: 10.2105/ajph.87.9.1461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gregoratos G., Cheitlin M. D., Conill A., Epstein A. E., Fellows C., Ferguson T. B., Jr, Freedman R. A., Hlatky M. A., Naccarelli G. V., Saksena S. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1998 Apr;31(5):1175–1209. doi: 10.1016/s0735-1097(98)00024-2. [DOI] [PubMed] [Google Scholar]
  11. Gregoratos Gabriel, Abrams Jonathan, Epstein Andrew E., Freedman Roger A., Hayes David L., Hlatky Mark A., Kerber Richard E., Naccarelli Gerald V., Schoenfeld Mark H., Silka Michael J. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation. 2002 Oct 15;106(16):2145–2161. doi: 10.1161/01.cir.0000035996.46455.09. [DOI] [PubMed] [Google Scholar]
  12. Groeneveld Peter W., Heidenreich Paul A., Garber Alan M. Racial disparity in cardiac procedures and mortality among long-term survivors of cardiac arrest. Circulation. 2003 Jun 30;108(3):286–291. doi: 10.1161/01.CIR.0000079164.95019.5A. [DOI] [PubMed] [Google Scholar]
  13. Groeneveld Peter W., Heidenreich Paul A., Garber Alan M. Trends in implantable cardioverter-defibrillator racial disparity: the importance of geography. J Am Coll Cardiol. 2005 Jan 4;45(1):72–78. doi: 10.1016/j.jacc.2004.07.061. [DOI] [PubMed] [Google Scholar]
  14. Hlatky Mark A., Saynina Olga, McDonald Kathryn M., Garber Alan M., McClellan Mark B. Utilization and outcomes of the implantable cardioverter defibrillator, 1987 to 1995. Am Heart J. 2002 Sep;144(3):397–403. doi: 10.1067/mhj.2002.125496. [DOI] [PubMed] [Google Scholar]
  15. Josephson M. E., Callans D. J., Buxton A. E. The role of the implantable cardioverter-defibrillator for prevention of sudden cardiac death. Ann Intern Med. 2000 Dec 5;133(11):901–910. doi: 10.7326/0003-4819-133-11-200012050-00015. [DOI] [PubMed] [Google Scholar]
  16. Kupersmith Joel. The past, present, and future of the implantable cardioverter defibrillator. Am J Med. 2002 Jul;113(1):82–84. doi: 10.1016/s0002-9343(02)01201-9. [DOI] [PubMed] [Google Scholar]
  17. Morel Carlos M., Acharya Tara, Broun Denis, Dangi Ajit, Elias Christopher, Ganguly N. K., Gardner Charles A., Gupta R. K., Haycock Jane, Heher Anthony D. Health innovation networks to help developing countries address neglected diseases. Science. 2005 Jul 15;309(5733):401–404. doi: 10.1126/science.1115538. [DOI] [PubMed] [Google Scholar]
  18. Zheng Z. J., Croft J. B., Giles W. H., Mensah G. A. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001 Oct 30;104(18):2158–2163. doi: 10.1161/hc4301.098254. [DOI] [PubMed] [Google Scholar]
  19. Zipes D. P., Wellens H. J. Sudden cardiac death. Circulation. 1998 Nov 24;98(21):2334–2351. doi: 10.1161/01.cir.98.21.2334. [DOI] [PubMed] [Google Scholar]

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