Supplementary data: Racial and ethnic differences in diagnosis, healthcare utilization and 1-year outcomes for patients with significant tricuspid regurgitation

<b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>Racial and ethnic differences in diagnosis, healthcare utilization and 1-year outcomes for patients with significant tricuspid regurgitation</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplemental Table 1: </b>Patient identification criteria for significant tricuspid regurgitation, by race/ethnicity<b>Supplemental Table 2:</b> Comorbidity burden over time.<b>Supplemental Table 3:</b> Unadjusted hazard ratios for one-year post-significant tricuspid regurgitation events, by race and ethnicity.<b>Supplemental Table 4: </b>Hazard ratios for all explanatory variables for all-cause mortality.<b>Supplemental Table 5: </b>Hazard ratios for all explanatory variables for heart failure hospitalization.<b>Background:</b> The impact of race and ethnicity on prognosis and clinical outcomes in patients with significant tricuspid regurgitation (sTR) is not well understood. <b>Aim: </b>Describe healthcare utilization trends preceding the development of sTR and assess clinical outcomes 1-year post-sTR status by race and ethnicity. <b>Materials &amp; methods:</b> We conducted a retrospective, longitudinal descriptive study using data from a large database containing electronic health record and insurance claims information.We employed multivariate modeling to assess the relationship between 1-year clinical outcomes and mutually exclusive race/ethnicity groups and other baseline factors. <b>Results: </b>Black patients were more likely to be identified as having sTR as inpatients when compared with White patients (p &lt; 0.001) and had fewer outpatient visits to cardiac specialists before and after developing sTR (p &lt; 0.01). Black and Hispanic patients with sTR were at increased risk of heart failure hospitalization compared with White patients at 1 year (adjusted HR: 1.21, 95% CI: 1.16–1.26, p &lt; 0.001 and adjusted HR: 1.10, 95% CI: 1.02–1.19, p &lt; 0.05 respectively). However, both Black and Hispanic patients had lower 1-year mortality thanWhite patients in the adjusted model. <b>Conclusion:</b> Black and Hispanic patients are less likely to have received outpatient care by a cardiac specialist prior to the development of sTR, and have higher rates of heart failure hospitalization after diagnosis. In contrast, their mortality rates following sTR identification are lower than White patients. Further investigation into the underlying mechanisms of these observations is needed to improve TR related outcomes.

本数据集为发表于《比较疗效研究杂志》（*Journal of Comparative Effectiveness Research*）的文章《重度三尖瓣反流患者的诊断、医疗服务利用及1年临床结局的种族/民族差异》的经同行评议补充材料。

补充表1：按种族/民族划分的重度三尖瓣反流（significant tricuspid regurgitation, sTR）患者识别标准
补充表2：随时间变化的共病负担
补充表3：按种族/民族划分的重度三尖瓣反流确诊后1年事件的未校正风险比
补充表4：全因死亡相关所有解释变量的风险比
补充表5：心力衰竭住院相关所有解释变量的风险比

**背景**：目前对于重度三尖瓣反流患者的种族/民族差异对其预后及临床结局的影响尚不明晰。

**研究目的**：明确重度三尖瓣反流发病前的医疗服务利用趋势，并按种族/民族评估重度三尖瓣反流确诊后1年的临床结局。

**材料与方法**：本研究采用回顾性纵向描述性研究设计，依托包含电子健康档案与保险理赔信息的大型数据库开展分析；通过多变量建模，探究1年临床结局与互斥种族/民族分组及其他基线特征之间的关联。

**研究结果**：与白人患者相比，黑人患者更易被确诊为住院相关性重度三尖瓣反流（p < 0.001），且在确诊重度三尖瓣反流前后的心脏专科门诊就诊次数更少（p < 0.01）。确诊重度三尖瓣反流后1年，黑人与西班牙裔患者的心力衰竭住院风险均高于白人患者（校正后风险比（hazard ratio, HR）：1.21，95%置信区间（confidence interval, CI）：1.16–1.26，p < 0.001；校正后HR：1.10，95%CI：1.02–1.19，p < 0.05）。但在校正模型中，黑人和西班牙裔患者的1年死亡率均低于白人患者。

**研究结论**：重度三尖瓣反流发病前，黑人和西班牙裔患者接受心脏专科门诊诊疗的比例更低；确诊后，他们的心力衰竭住院率更高，但确诊后的1年死亡率却低于白人患者。未来需进一步探究上述现象的潜在机制，以改善三尖瓣反流相关临床结局。