National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999–2020)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Statistical Analysis
2.3. Ethical Statement
3. Results
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Kim, K.M.; Arghami, A.; Habib, R.; Daneshmand, M.A.; Parsons, N.; Elhalabi, Z.; Krohn, C.; Thourani, V.; Bowdish, M.E. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 Update on Outcomes and Research. Ann. Thorac. Surg. 2023, 115, 566–574. [Google Scholar] [CrossRef] [PubMed]
- Wu, J.; Cong, X.; Lou, Z.; Zhang, M. Trend and Impact of Concomitant CABG and Multiple-Valve Procedure on In-hospital Outcomes of SAVR Patients. Front. Cardiovasc. Med. 2021, 8, 740084. [Google Scholar] [CrossRef] [PubMed]
- Melly, L.; Torregrossa, G.; Lee, T.; Jansens, J.L.; Puskas, J.D. Fifty years of coronary artery bypass grafting. J. Thorac. Dis. 2018, 10, 1960–1967. [Google Scholar] [CrossRef]
- Ma, W.G.; Hou, B.; Abdurusul, A. Dysfunction of mechanical heart valve prosthesis: Experience with surgical management in 48 patients. J. Thorac. Dis. 2015, 7, 2321–2329. [Google Scholar] [CrossRef]
- Maribas, P. Management of prosthetic heart valve obstruction: Speech for the surgery? Arch. Cardiovasc. Dis. 2009, 102, 255–257. [Google Scholar] [CrossRef] [PubMed]
- Harik, L.; Perezgrovas-Olaria, R.; Soletti, G., Jr.; Dimagli, A.; Alzghari, T.; An, K.R.; Cancelli, G.; Gaudino, M.; Sandner, S. Graft thrombosis after coronary artery bypass surgery and current practice for prevention. Front. Cardiovasc. Med. 2023, 10, 1125126. [Google Scholar] [CrossRef]
- Aschacher, T.; Baranyi, U.; Aschacher, O.; Eichmair, E.; Messner, B.; Zimpfer, D. A novel endothelial damage inhibitor reduces oxidative stress and improves cellular integrity in radial artery grafts for coronary artery bypass. Front. Cardiovasc. Med. 2021, 8, 736503. [Google Scholar] [CrossRef] [PubMed]
- Ali, M.R.; Nacer, H.; Lawson, C.A.; Khunti, K. Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease. Can. J. Cardiol. 2024, 40, 1016–1030. [Google Scholar] [CrossRef] [PubMed]
- Javed, Z.; Haisum Maqsood, M.; Yahya, T. Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease. Circ. Cardiovasc. Qual. Outcomes 2022, 15, e007917. [Google Scholar] [CrossRef] [PubMed]
- Mehtsun, W.T.; Figueroa, J.F.; Zheng, J.; Orav, E.J.; Jha, A.K. Racial disparities in surgical mortality: The gap appears to have narrowed. Health Aff. 2017, 36, 1057–1064. [Google Scholar] [CrossRef]
- Khera, R.; Vaughan-Sarrazin, M.; Rosenthal, G.E.; Girotra, S. Racial disparities in outcome after cardiac surgery: The role of hospital quality. Curr. Cardiol. Rep. 2015, 17, 29. [Google Scholar] [CrossRef] [PubMed]
- Shah, N.S.; Lloyd-Jones, D.M.; O’Flaherty, M. Trends in Cardiometabolic Mortality in the United States, 1999–2017. JAMA 2019, 322, 780–782. [Google Scholar] [CrossRef] [PubMed]
- Kim, H.J.; Fay, M.P.; Feuer, E.J.; Midthune, D.N. Permutation tests for joinpoint regression with applications to cancer rates. Stat. Med. 2000, 19, 335–351, Erratum in Stat. Med. 2001, 20, 655. [Google Scholar] [CrossRef]
- Scott, S.S.; Gouchoe, D.A.; Azap, L.; Henn, M.C.; Choi, K.; Mokadam, N.A.; Whitson, B.A.; Pawlik, T.M.; Ganapathi, A.M. Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery. Curr. Cardiovasc. Risk Rep. 2024, 18, 95–113. [Google Scholar] [CrossRef] [PubMed]
- Muscoli, S.; Andreadi, A.; Tamburro, C.; Russo, M.; Rosenfeld, R.; Oro, P.; Ifrim, M.; Porzio, F.; Barone, L.; Barillà, F.; et al. Prevalence of Cardiovascular Risk Factors and Coronary Angiographic Findings in High-Risk Immigrant Communities in Italy. J. Pers. Med. 2023, 13, 882. [Google Scholar] [CrossRef]
- Silbiger, J.J.; Ashtiani, R.; Attari, M.; Spruill, T.M.; Kamran, M.; Reynolds, D.; Stein, R.; Rubinstein, D. Atheroscerlotic heart disease in Bangladeshi immigrants: Risk factors and angiographic findings. Int. J. Cardiol. 2011, 146, e38–e40. [Google Scholar] [CrossRef]
- Movsisyan, N.K.; Vinciguerra, M.; Medina-Inojosa, J.R.; Lopez-Jimenez, F. Cardiovascular Diseases in Central and Eastern Europe: A Call for More Surveillance and Evidence-Based Health Promotion. Ann. Glob. Health 2020, 86, 21. [Google Scholar] [CrossRef] [PubMed]
- Alhabib, K.F.; Gamra, H.; Almahmeed, W.; Hammoudeh, A.; Benkheddah, S.; Al Jarallah, M.; Al-Motarreb, A.; Alquraishi, M.; Sobhy, M.; Yousif, M.G.; et al. Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry. PLoS ONE 2020, 15, e0236292. [Google Scholar] [CrossRef]
- Traina, M.I.; Almahmeed, W.; Edris, A.; Murat Tuzcu, E. Coronary Heart Disease in the Middle East and North Africa: Current Status and Future Goals. Curr. Atheroscler. Rep. 2017, 19, 24. [Google Scholar] [CrossRef] [PubMed]
- Widmer, R.J.; Flammer, A.J.; Lerman, L.O.; Lerman, A. The Mediterranean Diet, its Components, and Cardiovascular Disease. Am. J. Med. 2015, 128, 229–238. [Google Scholar] [CrossRef] [PubMed]
- Rangrass, G.; Ghaferi, A.A.; Dimick, J.B. Explaining racial disparities in outcomes after cardiac surgery: The role of hospital quality. JAMA Surg. 2014, 149, 223–227. [Google Scholar] [CrossRef]
- Mehta, R.H.; Shahian, D.M.; Sheng, S.; O’Brien, S.M.; Edwards, F.H.; Jacobs, J.P.; Peterson, E.D. Association of Hospital and Physician Characteristics and Care Processes with Racial Disparities in Procedural Outcomes Among Contemporary Patients Undergoing Coronary Artery Bypass Grafting Surgery. Circulation 2016, 133, 124–130. [Google Scholar] [CrossRef] [PubMed]
- Trivedi, A.N.; Sequist, T.D.; Ayanian, J.Z. Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality. J. Am. Coll. Cardiol. 2006, 47, 417–424. [Google Scholar] [CrossRef] [PubMed]
- Castellanos, L.R.; Normand, S.L.T.; Ayanian, J.Z. Racial and Ethnic Disparities in Access to Higher and Lower Quality Cardiac Surgeons for Coronary Artery Bypass Grafting. Am. J. Cardiol. 2009, 103, 1682–1686. [Google Scholar] [CrossRef] [PubMed]
- Berger, A.; MacCarthy, P.A.; Siebert, U.; Carlier, S.; Wijns, W.; Heyndrickx, G.; Bartunek, J.; Vanermen, H.; De Bruyne, B. Long-Term Patency of Internal Mammary Artery Bypass Grafts: Relationship with Preoperative Severity of the Native Coronary Artery Stenosis. Circulation 2004, 110 (Suppl. S1), II36–II40. [Google Scholar] [CrossRef]
- Ruel, M.; Rubens, F.D.; Masters, R.G.; Pipe, A.L.; Bédard, P.; Mesana, T.G. Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves. J. Thorac. Cardiovasc. Surg. 2004, 128, 278–283. [Google Scholar] [CrossRef]
- Zaouter, C.; Oses, P.; Assatourian, S.; Labrousse, L.; Rémy, A.; Ouattara, A. Reduced Length of Hospital Stay for Cardiac Surgery-Implementing an Optimized Perioperative Pathway: Prospective Evaluation of an Enhanced Recovery after Surgery Program Designed for Mini-Invasive Aortic Valve Replacement. J. Cardiothorac. Vasc. Anesth. 2019, 33, 3010–3019. [Google Scholar] [CrossRef] [PubMed]
- Sutton, T.S.; McKay, R.G.; Mather, J.; Takata, E.; Eschert, J.; Cox, M.; Douglas, A.; McLaughlin, T.; Loya, D.; Mennett, R.; et al. Enhanced Recovery after Surgery Is Associated with Improved Outcomes and Reduced Racial and Ethnic Disparities after Isolated Coronary Artery Bypass Surgery: A Retrospective Analysis with Propensity-Score Matching. J. Cardiothorac. Vasc. Anesth. 2022, 36, 2418–2431. [Google Scholar] [CrossRef] [PubMed]
- Mehaffey, J.H.; Hawkins, R.B.; Charles, E.J.; Thibault, D.; Williams, M.L.; Brennan, M.; Thourani, V.H.; Badhwar, V.; Ailawadi, G. Distressed communities are associated with worse outcomes after coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg. 2020, 160, 425–432.e9. [Google Scholar] [CrossRef]
- Hannan, E.L.; Wu, Y.; Cozzens, K.; Friedrich, M.; Chikwe, J.; Adams, D.H.; Sundt, I.I.I.T.M.; Girardi, L.; Smith, C.R.; Lahey, S.J.; et al. The Association of Socioeconomic Factors with Outcomes for Coronary Artery Bypass Surgery. Ann. Thorac. Surg. 2022, 114, 1318–1325. [Google Scholar] [CrossRef]
- Cohen, B.D.; Zeymo, A.; Bouchard, M.; McDermott, J.; Shara, N.M.; Sellke, F.W.; Sodha, N.; Al-Refaie, W.B.; Ehsan, A. Increased Access to Cardiac Surgery Did Not Improve Outcomes: Early Look Into Medicaid Expansion. Ann. Thorac. Surg. 2022, 114, 1637–1644. [Google Scholar] [CrossRef] [PubMed]
- Bach, P.B.; Pham, H.H.; Schrag, D.; Tate, R.C.; Hargraves, J.L. Primary Care Physicians Who Treat Blacks and Whites. N. Engl. J. Med. 2004, 351, 575–584. [Google Scholar] [CrossRef]
- Brennan, J.M.; Bryant, A.; Boero, I.; Wang, T.; Vemulapalli, S.; Thourani, V.; Leon, M.; Peterson, E. Race and sex-based disparities persist in the treatment of patients with severe, symptomatic aortic valve stenosis. J. Am. Coll. Cardiol. 2019, 73, 1207. [Google Scholar] [CrossRef]
- Cruz Rodriguez, B.; Acharya, P.; Salazar-Fields, C.; Horne, A. Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites. Am. J. Cardiol. 2017, 120, 450–455. [Google Scholar] [CrossRef] [PubMed]
- Sleder, A.; Tackett, S.; Cerasale, M.; Mittal, C.; Isseh, I.; Radjef, R.; Taylor, A.; Farha, R.; Lupak, O.; Larkin, D.; et al. Socioeconomic and Racial Disparities: A Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis. J. Racial Ethn. Health Disparities 2017, 4, 1189–1194. [Google Scholar] [CrossRef]
- Nathan, A.S.; Yang, L.; Yang, N.; Eberly, L.A.; Khatana, S.A.; Dayoub, E.J.; Vemulapalli, S.; Julien, H.; Cohen, D.J.; Nallamothu, B.K.; et al. Racial, Ethnic, and Socioeconomic Disparities in Access to Transcatheter Aortic Valve Replacement within Major Metropolitan Areas. JAMA Cardiol. 2022, 7, 150. [Google Scholar] [CrossRef] [PubMed]
- Gupta, A.; Mori, M.; Wang, Y.; Pawar, S.G.; Vahl, T.; Nazif, T.; Onuma, O.; Yong, C.M.; Sharma, R.; Kirtane, A.J.; et al. Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012–2019. Am. J. Med. 2024, 137, 321–330.e7. [Google Scholar] [CrossRef] [PubMed]
- Milam, A.J.; Ogunniyi, M.O.; Faloye, A.O.; Castellanos, L.R.; Verdiner, R.E.; Stewart, J.W.; Chukumerije, M.; Okoh, A.K.; Bradley, S.; Roswell, R.O.; et al. Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery. J. Am. Coll. Cardiol. 2024, 83, 530–545. [Google Scholar] [CrossRef] [PubMed]
- Aragam, K.G.; Dai, D.; Neely, M.L.; Bhatt, D.L.; Roe, M.T.; Rumsfeld, J.S.; Gurm, H.S. Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States. J. Am. Coll. Cardiol. 2015, 65, 2079–2088. [Google Scholar] [CrossRef] [PubMed]
- Chindhy, S.; Taub, P.R.; Lavie, C.J.; Shen, J. Current challenges in cardiac rehabilitation: Strategies to overcome social factors and attendance barriers. Expert Rev. Cardiovasc. Ther. 2020, 18, 777–789. [Google Scholar] [CrossRef] [PubMed]
- Garfein, J.; Guhl, E.N.; Swabe, G.; Sekikawa, A.; Barinas-Mitchell, E.; Forman, D.E.; Magnani, J.W. Racial and Ethnic Differences in Cardiac Rehabilitation Participation: Effect Modification by Household Income. J. Am. Heart Assoc. 2022, 11, e025591. [Google Scholar] [CrossRef] [PubMed]
- Ritchey, M.D.; Maresh, S.; McNeely, J.; Shaffer, T.; Jackson, S.L.; Keteyian, S.J.; Brawner, C.A.; Whooley, M.A.; Chang, T.; Stolp, H.; et al. Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative. Circ. Cardiovasc. Qual. Outcomes 2020, 13, e005902. [Google Scholar] [CrossRef]
- Roudaut, R.; Lafitte, S.; Roudaut, M.F. Management of prosthetic heart valve obstruction: Fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases. Arch. Cardiovasc. Dis. 2009, 102, 269–277. [Google Scholar] [CrossRef] [PubMed]
- Rizzoli, G.; Guglielmi, C.; Toscano, G. Reoperations for acute prosthetic thrombosis and pannus: An assessment of rates, relationship and risk. Eur. J. Cardiothorac. Surg. 1999, 16, 74–80. [Google Scholar] [CrossRef]
- Essien, U.R.; Holmes, D.N.; Jackson, L.R.; Fonarow, G.C.; Mahaffey, K.W.; Reiffel, J.A.; Steinberg, B.A.; Allen, L.A.; Chan, P.S.; Freeman, J.V.; et al. Association of Race/Ethnicity with Oral Anticoagulant Use in Patients with Atrial Fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II. JAMA Cardiol. 2018, 3, 1174–1182. [Google Scholar] [CrossRef]
- Schauer, D.P.; Johnston, J.A.; Moomaw, C.J.; Wess, M.; Eckman, M.H. Racial disparities in the filling of warfarin prescriptions for nonvalvular atrial fibrillation. Am. J. Med. Sci. 2007, 333, 67–73. [Google Scholar] [CrossRef] [PubMed]
- Nathan, A.S.; Geng, Z.; Dayoub, E.J. Racial, Ethnic, and Socioeconomic Inequities in the Prescription of Direct Oral Anticoagulants in Patients with Venous Thromboembolism in the United States. Circ. Cardiovasc. Qual. Outcomes 2019, 12, e005600. [Google Scholar] [CrossRef]
- Reynolds, K.R.; Khosrow-Khavar, F.; Dave, C.V. Racial and Ethnic Disparities in Initiation of Direct Oral Anticoagulants Among Medicare Beneficiaries. JAMA Netw. Open 2024, 7, e249465. [Google Scholar] [CrossRef] [PubMed]
- Stevens, S.M.; Woller, S.C.; Baumann Kreuziger, L. Executive Summary: Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021, 160, 2247–2259. [Google Scholar] [CrossRef] [PubMed]
- Meschia, J.F.; Merrill, P.; Soliman, E.Z. Racial disparities in awareness and treatment of atrial fibrillation: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke 2010, 41, 581–587. [Google Scholar] [CrossRef]
- Essien, U.R.; Kim, N.; Magnani, J.W. Association of Race and Ethnicity and Anticoagulation in Patients with Atrial Fibrillation Dually Enrolled in Veterans Health Administration and Medicare: Effects of Medicare Part D on Prescribing Disparities. Circ. Cardiovasc. Qual. Outcomes 2022, 15, e008389. [Google Scholar] [CrossRef]
- Jha, A.K.; Epstein, A.M. A survey of board chairs of English hospitals shows greater attention to quality of care than among their US counterparts. Health Aff. 2013, 32, 677–685. [Google Scholar] [CrossRef]
- Dani, S.S.; Minhas, A.M.K.; Arshad, A.; Krupica, T.; Goel, S.S.; Virani, S.S.; Sharma, G.; Blankstein, R.; Blaha, M.J.; Al-Kindi, S.G.; et al. Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018. J. Am. Heart Assoc. 2021, 10, e021361. [Google Scholar] [CrossRef]
- Elbadawi, A.; Hamed, M.; Elgendy, I.Y.; Omer, M.A.; Ogunbayo, G.O.; Megaly, M.; Denktas, A.; Ghanta, R.; Jimenez, E.; Brilakis, E.; et al. Outcomes of Reoperative Coronary Artery Bypass Graft Surgery in the United States. J. Am. Heart Assoc. 2020, 9, e016282. [Google Scholar] [CrossRef]
- Harvey, J.E., 3rd; Kapadia, S.R.; Cohen, D.J.; Kalra, A.; Irish, W.; Gunnarsson, C.; Ryan, M.; Chikermane, S.G.; Thompson, C.; Puri, R. Trends in Complications Among Patients Undergoing Aortic Valve Replacement in the United States. J. Am. Heart Assoc. 2024, 13, e031461. [Google Scholar] [CrossRef] [PubMed]
- Abri, Q.A.; von Ballmoos, M.C.W. Cardiovascular Surgery Procedural Training and Evaluation: Current Status and Future Directions. Methodist Debakey Cardiovasc. J. 2022, 18, 30–38. [Google Scholar] [CrossRef]
- Bowdish, M.E.; D’Agostino, R.S.; Thourani, V.H.; Desai, N.; Shahian, D.M.; Fernandez, F.G.; Badhwar, B. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2020 Update on Outcomes and Research. Ann. Thorac. Surg. 2020, 109, 1646–1655. [Google Scholar] [CrossRef] [PubMed]
- Chang, J.; Medina, M.; Shin, D.Y.; Kim, S.J. Racial disparity and regional variance in healthcare utilization among patients with lung cancer in US hospitals during 2016–2019. Arch. Public Health 2023, 81, 150. [Google Scholar] [CrossRef]
- Revankar, S.; Agarwala, A. Stepping Away from the Monolith: The Disaggregation of Asian Cardiovascular Data. Am. J. Cardiol. 2024, 219, 120–122. [Google Scholar] [CrossRef] [PubMed]
- Min, L.Y.; Islam, R.B.; Gandrakota, N.; Shah, M.K. The social determinants of health associated with cardiometabolic diseases among Asian American subgroups: A systematic review. BMC Health Serv. Res. 2022, 22, 257. [Google Scholar] [CrossRef]
- Ghisi, G.L.M.; Chaves, G.S.D.S.; Britto, R.R.; Oh, P. Health literacy and coronary artery disease: A systematic review. Patient Educ. Couns. 2018, 101, 177–184. [Google Scholar] [CrossRef] [PubMed]
- Marcolino, M.; Sales, T.; Rios, D.; Pedroso, T.M.; Sá, L.C.; Martins, M.A.; Ribeiro, A.L. Health Literacy, Patient Knowledge and Adherence to Oral Anticoagulation in Primary Care. Int. J. Cardiovasc. Sci. 2023, 36, e20220158. [Google Scholar] [CrossRef]
Age-Adjusted Mortality Rate per 100,000 (95% CI) | Relative Percent Change (95% CI) | Annual Average Percent Change (p-Value) | ||
---|---|---|---|---|
1999 | 2020 | |||
Total | 2.21 (2.16–2.27) | 0.88 (1.05–0.88) | −60.18 (51.39–61.23) | −9.5 (p = 0.013) |
Race and Ethnic Group | ||||
White | 2.26 (2.2–2.32) | 0.83 (0.8–0.86) | −63.27 (62.93–63.63) | −9.7 (p < 0.001) |
Black | 2.45 (2.24–2.64) | 1.31 (1.2–1.42) | −46.53 (46.21–46.62) | −11.3 (p < 0.001) |
Hispanic | 1.44 (1.24–1.64) | 0.72 (0.63–0.8) | −50.00 (49.19–51.22) | −6.8 (p = 0.027) |
Non-Hispanic | 2.26 (2.2–2.32) | 0.89 (0.85–0.92) | −60.62 (60.34–61.36) | −9.3 (p < 0.001) |
AIAN | 2.37 (1.61–3.36) | 0.95 (0.61–1.42) | −59.92 (57.74–62.11) | −9.2 (p < 0.001) |
AAPI | 1.58 (1.26–1.9) | 0.48 (0.39–0.57) | −69.62 (69.05–70.00) | −6.2 (p = 0.036) |
Sex | ||||
Female | 1.75 (1.69–1.82) | 0.65 (0.61–0.68) | −62.86 (62.64–63.91) | −6.2 (p = 0.031) |
Male | 2.86 (2.76–2.96) | 1.16 (1.11–1.21) | −59.44 (59.12–59.78) | −8.9 (p = 0.0056) |
Age Group (Years) | ||||
0–44 | 0.15 (0.13–0.17) | 0.1 (0.09–0.12) | −33.33 (29.41–33.76) | −1.2 (p = 0.55) |
45–64 | 1.96 (1.85–2.08) | 1.05 (0.98–1.12) | −46.43 (46.15–47.03) | −3.5 (p = 0.032) |
>65 | 13.31 (12.92–13.69) | 4.58 (4.4–4.76) | −65.59 (65.23–65.94) | −11.7 (p < 0.001) |
US Census Regions | ||||
Northeast | 2.07 (1.95–2.18) | 0.69 (0.63–0.76) | −66.67 (65.14–67.69) | −8.9 (p < 0.001) |
Midwest | 2.22 (2.11–2.34) | 0.88 (0.82–0.94) | −60.36 (59.83–61.14) | −2.1 (p = 0.53) |
South | 2.55 (2.45–2.65) | 0.95 (0.9–1.0) | −62.75 (62.26–63.27) | −10.2 (p < 0.001) |
West | 1.77 (1.66–1.88) | 0.83 (0.77–0.89) | −53.11 (52.66–53.61) | −6.3 (p = 0.033) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kwon, Y.I.C.; Zhu, D.T.; Lai, A.; Park, A.M.-G.; Chery, J.; Hashmi, Z.A. National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999–2020). J. Clin. Med. 2025, 14, 562. https://doi.org/10.3390/jcm14020562
Kwon YIC, Zhu DT, Lai A, Park AM-G, Chery J, Hashmi ZA. National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999–2020). Journal of Clinical Medicine. 2025; 14(2):562. https://doi.org/10.3390/jcm14020562
Chicago/Turabian StyleKwon, Ye In Christopher, David T. Zhu, Alan Lai, Andrew Min-Gi Park, Josue Chery, and Zubair A. Hashmi. 2025. "National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999–2020)" Journal of Clinical Medicine 14, no. 2: 562. https://doi.org/10.3390/jcm14020562
APA StyleKwon, Y. I. C., Zhu, D. T., Lai, A., Park, A. M.-G., Chery, J., & Hashmi, Z. A. (2025). National Trends in Racial and Ethnic Disparities in Mortality from Mechanical Complications of Cardiac Valves and Grafts (1999–2020). Journal of Clinical Medicine, 14(2), 562. https://doi.org/10.3390/jcm14020562