Racial and ethnic disparities in heart transplantation for end-stage heart failure: An analysis of the national inpatient sample (NIS) database.

ABSTRACT

PURPOSE: This study aims to examine disparities among heart transplant recipients in the United States, utilizing the latest data from the National Inpatient Sample (NIS). METHODS: We conducted a retrospective cohort analysis of NIS discharge data (2017-2020), focusing on adult end-stage heart failure (ESHF) patients, identified using the ICD-10 CM code I50.84. Our analysis included four racial groups White, Black, Hispanic, and Asian. We employed univariable and multivariate regression analyses to determine the unadjusted and adjusted odds of heart transplantation across these racial groups, using Stata version 14.2 for statistical calculations. RESULTS: Of 110,015 ESHF patients, 3,695 received heart transplants. Predominantly, recipients were male with a Charlson comorbidity index ≥3 and covered by private insurance. Transplants mainly occurred in large, teaching hospitals. Despite minor differences in age and median household income among races, baseline patient and hospital characteristics showed no significant variations. Compared to Whites, Blacks had a significantly lower transplant rate (AOR 0.6; 95  % CI 0.46-0.77; p < 0.001), while Hispanics and Asians showed no significant disparities. Mean ages varied slightly across groups (p = 0.0047), yet inpatient length of stay and hospitalization costs did not significantly differ. CONCLUSION: Our findings highlight a significant disparity in heart transplant rates between Black and White ESHF patients in the U.S., with Black patients less likely to receive transplants compared to their White counterparts.