Mortality, readmission rates elevated among socioeconomically disadvantaged adults with PE
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One-year mortality and 90-day readmission rates were higher among socioeconomically disadvantaged older adults hospitalized with pulmonary embolism compared with nondisadvantaged older patients with PE, researchers reported.
“Understanding whether patterns of care and outcomes differ between socioeconomically disadvantaged and nondisadvantaged older adults is important given that the clinical burden of PE is high and rising in this population and may inform strategies to improve care and reduce health disparities,” Rishi K. Wadhera, MD, MPP, MPhil, cardiologist at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical and assistant professor of medicine at Harvard Medical School, and colleagues wrote in the Journal of the American Heart Association.
Researchers assessed 53,386 Medicare beneficiaries aged 65 years or older who were hospitalized for PE from October 2015 to January 2017; 10.3% of patients were defined as socioeconomically disadvantaged. When comparing the socioeconomically disadvantaged adults to their nondisadvantaged counterparts, researchers observed similar ages (disadvantaged, 77.1 years; nondisadvantaged, 77 years) but noted the disadvantaged group was more likely to be female (68.5% vs. 54.2%) and less likely to receive advanced therapies (11% vs. 12.1%).
Compared with nondisadvantaged adults, socioeconomically disadvantaged adults showed similar observed in-hospital (HR = 0.95; 95% CI, 0.83-1.09; P = .66) and 90-day (HR = 1.05; 95% CI, 0.98-1.12; P = .1) mortality rates. However, higher 1-year mortality rates were observed among socioeconomically disadvantaged adults compared with nondisadvantaged counterparts (30.5% vs. 25.9%; HR = 1.16; 95% CI, 1.1-1.22), but these differences began to reduce after adjustments for comorbidities and severity of PE (adjusted HR = 1.09; 95% CI, 1.02-1.16).
Socioeconomically disadvantaged adults with PE demonstrated substantially higher 30-day (18.1% vs. 13.7%; aHR = 1.14; 95% CI, 1.06-1.22) and 90-day (32.4% vs. 24.1%; aHR = 1.18; 95% CI, 1.12-1.25) all-cause readmission rates compared with nondisadvantaged adults with PE. Readmission rates for PE, deep vein thrombosis and/or bleeding were higher among socioeconomically disadvantaged older adults at 30 days (3.3% vs. 2.6%; aHR = 1.16; 95% CI, 0.99-1.38) and 90 days (5.6% vs. 4.3%; aHR = 1.16; 95% CI, 1.02-1.32) compared with those who were not disadvantaged.
According to the researchers, the 1-year mortality findings were reassuring because they suggest quality of care may not be markedly different between socioeconomically disadvantaged and nondisadvantaged groups during acute hospitalizations.
“To reduce hospital readmissions and mortality in this vulnerable population, targeted resources and innovative interventions are needed to improve the transition from inpatient to outpatient care and to provide greater access to more integrated outpatient care,” the researchers wrote.
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