Abstract 4369281: Demographic Disparities in Tafamidis Treatment and Clinical Outcomes Across the United States
Bibliographic record
Abstract
Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, often fatal disease. A better understanding of demographic disparities in diagnosis and treatment is crucial to optimize care and improve outcomes across diverse patient (pt) populations. Objectives: To evaluate potential differences in initiation of tafamidis, the only approved ATTR-CM therapy at the time of the study, and subsequent clinical outcomes by gender and race. We hypothesized that significant demographic differences exist in treatment patterns and clinical outcomes. Methods: We conducted a retrospective cohort analysis using the US Komodo Healthcare Map ® (01/2016-06/2024). Pts with amyloidosis ICD-10-CM diagnosis codes were identified and followed from diagnosis to tafamidis initiation and cardiovascular-related hospitalization (CVH) or death. Cumulative incidence of treatment initiation and survival probabilities were stratified by gender and race. Results: We identified 11,311 pts with ATTR-CM (63.9% men [mean age, 73.5 y] and 36.1% women [mean age, 72.4 y]). After diagnosis, women had a significantly lower cumulative incidence of tafamidis initiation compared to men at all time points ( P <0.001). At 3 mo after diagnosis, the cumulative incidence was 9.9% among women versus 19.9% among men; by 12 mo, this gap persisted (14.5% vs 28.5%). Race further compounded these disparities ( P <0.001; Figure 1 ). At 12 mo, White men had the highest cumulative incidence of initiation (31.0%), followed by Black men (26.7%), Black women (22.0%), and White women (11.4%). CVH or death occurred in 57.7% of women versus 53.6% of men. Event-free survival at 12 mo was lowest in Black women (42.9%) versus Black men (46.8%), White women (48.6%), and White men (54.4%) ( P <0.001; Figure 2 ). Black women experienced the shortest median (95% CI) time to CVH or death (8.0 mo [6.8-10.0]), followed by Black men (9.9 mo [8.8-12.0]), White women (11.0 mo [9.6-13.0]), and White men (15.0 mo [14.0-16.0]; Table ). Conclusion: This large-scale analysis of a US cohort suggests existing gender and racial disparities in tafamidis treatment initiation and outcomes in ATTR-CM. White women had the lowest rates of tafamidis initiation, while Black women had the worst clinical outcomes, highlighting a compounded disparity in treatment and survival by gender and race. These findings underscore the urgent need to address demographic-based disparities and ensure equitable care for all pts with ATTR-CM.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".