Abstract P3061: Uncovering Neighborhood-Level Inequities in Access to Transthoracic Echocardiograms

Abstract

Methods: From a sample cohort of 274,539 consecutive adults who sought care at Mayo Clinic between 2018-2022, we ascertained demographic and clinical information, including clinically indicated TTE within 15 days and up to a year after the index clinical visit. The Area Deprivation Index (ADI), a tool that captures neighborhood-level disadvantages that are linked to cardiovascular morbidity and outcomes, was extracted from the Neighborhood Atlas and ranked accordingly as state percentiles stratified in quintiles, with the highest values representing “most disadvantaged” areas. We performed non-parametric multivariate regression models that adjusted for cardiovascular risk factors expressed in odds ratio (OR) and 95% confidence interval (CI). Results: A total of 45,823 (16.9%) subjects had a TTE performed, with a mean age of 63±16 years, 48% were women, and 86% were non-Hispanic white. According to the TTE, 4% of subjects had LVSD, while 11% had a high probability of LVSD by AI-ECG. Median state ADI was 4 IQR (2-7). In the whole cohort, subjects residing in the most disadvantaged areas were less likely to have a TTE [OR 0.94 CI (0.91- 0.97)] see Fig. 1-A ; conversely, they were more likely to have LVSD by TTE [OR 1.80 CI (1.52-2.13)] see Fig. 1-B , and higher probability of LVSD by AI-ECG [OR 1.43 CI (1.36-1.51)] when compared to those with the least disadvantage see Fig. 1-C , independent of age, sex, and cardiovascular risk factors, p for trend<0.001. Conclusion: Individuals living in socially disadvantaged areas were slightly less likely to have an echocardiogram despite a significantly higher likelihood of having an LVSD (suspected by AI-ECG and confirmed by TTE), independent of cardiovascular risk factors. Highlighting an important disparity in the diagnosis of LVSD.