Browsing by Author "Bolakale-Rufai, Ikeoluwapo Kendra"

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    Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases
    (Wiley, 2025) Bolakale-Rufai, Ikeoluwapo Kendra; Knapp, Shannon M.; Bisono, Janina Quintero; Johnson, Adedoyin; Moore, Wanda; Yankah, Ekow; Yee, Ryan; Trabue, Dalancee; Nallamothu, Brahmajee; Hollingsworth, John M.; Watty, Stephen; Williamson, Francesca; Pool, Natalie; Hebdon, Megan; Ezema, Nneamaka; Capers, Quinn; Blount, Courtland; Kimbrough, Nia; Johnson, Denee; Evans, Jalynn; Foree, Brandi; Holman, Anastacia; Lightbourne, Karen; Brown, David; Tucker Edmonds, Brownsyne; Breathett, Khadijah; Medicine, School of Medicine
    Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival. Methods and results: Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P = 0.37]. Conclusions: Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.
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    Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement
    (Elsevier, 2024) Bolakale-Rufai, Ikeoluwapo Kendra; Shinnerl, Alexander; Knapp, Shannon M.; Johnson, Amber E.; Mohammed, Selma; Brewer, LaPrincess; Torabi, Asad; Addison, Daniel; Mazimba, Sula; Breathett, Khadijah; Medicine, School of Medicine
    Background: Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and results: Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. Results: Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)]. Conclusions: Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.
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    Relationship Between Race, Predelivery Cardiology Care, and Cardiovascular Outcomes in Preeclampsia/Eclampsia Among a Commercially Insured Population
    (Wolters Kluwer, 2025) Bolakale-Rufai, Ikeoluwapo Kendra; Knapp, Shannon M.; Tucker Edmonds, Brownsyne; Khan, Sadiya; Brewer, LaPrincess C.; Mohammed, Selma; Johnson, Amber; Mazimba, Sula; Addison, Daniel; Breathett, Khadijah; Medicine, School of Medicine
    Background: It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. Methods: Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. Results: Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21-0.46]; P<0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60-1.67]; P=0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (P<0.001) but not the remainder of the year (P=0.56). Conclusions: Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.