Declining use of percutaneous coronary intervention across population groups, 2011-2022

TL;DR

The use of percutaneous coronary intervention (PCI) decreased over time in California, with differences based on race, income, and insurance type.

Contribution

This study provides population-based trends of PCI utilization and sociodemographic disparities in California from 2011 to 2022.

Findings

PCI and cardiac catheterization rates decreased from 2011 to 2013, plateaued, and declined again in 2020.

Higher PCI shares were associated with higher income, private insurance, and White or Asian/Pacific Islander race.

Sociodemographic disparities in PCI shares persisted despite Medicaid expansion.

Abstract

Coronary revascularization rates declined with decreasing acute coronary syndrome (ACS) and evolving appropriate use criteria (AUC). Population-based utilization trends by sociodemographic categories have not been assessed.

We examined annual trends of all cardiac catheterizations and percutaneous coronary interventions (PCI) in California, 2011-2022, using the Health Care Access and Information database. We compared the PCI shares of cardiac catheterizations (“PCI shares”) between sociodemographic and facility-type strata. Regression models assessed significance of linear trends; pairwise comparisons assessed differences between strata.

We identified 1 839 444 cardiac catheterizations between 2011 and 2022. Catheterizations and PCI decreased from 2011 to 2013, plateaued, then decreased again in 2020. Higher median zip code family income, private insurance, and White or Asian/Pacific Islander, compared to Black or Hispanic, race were associated with higher PCI shares.

Califoirnia's PCI share decreased, likely with decreasing ACS and AUC for coronary revascularization. Decreasing PCI but not cardiac catheterizations suggests that the contributors to fewer interventional procedures did not affect diagnostic procedure rates. Sociodemographic and payer differences in the PCI share persisted throughout the study, despite Medicaid expansion. The PCI share of cardiac catheterizations may be a useful measure of utilization heterogeneity across sociodemographic strata.

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