Racial, ethnic minorities less likely to receive advanced therapies for pulmonary embolism
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Members of racial and ethnic minority groups had lower odds of receiving advanced therapies for pulmonary embolism and higher odds of in-hospital mortality compared with white individuals, according to study results.
The findings, presented during a virtual press briefing ahead of ASH Annual Meeting and Exposition, also showed disparities in PE treatment and outcomes based on income level and insurance type.
Background
“Social determinants of health like race, ethnicity and socioeconomic status are associated with many adverse health outcomes, including all-cause mortality,” Mary Cushman, MD, MSc, of the division of hematology and oncology in the department of medicine at Larner College of Medicine at University of Vermont, said during the briefing. “As one example, Black people have an approximately twofold greater mortality from pulmonary embolism compared [with] other groups, and this is a persistently observed disparity over many years.”
Cushman and colleagues used Nationwide Inpatient Sample data from 2016 to 2018 to examine relationships between social determinants of health and hospital management and fatality of patients hospitalized with PE.
Methodology
The study included 1.12 million adults hospitalized for PE, including 66,570 with high-risk PE. Social determinants of health included race and ethnicity, household income indexed based on neighborhood of residence and primary payer type (Medicare, Medicaid or private insurance).
Researchers investigated which patients received advanced therapies for PE, such as systemic thrombolysis, catheter-directed therapy, surgical embolectomy and veno-arterial extracorporeal membrane oxygenation. Next, they evaluated in-hospital mortality rates and length of stay.
The investigators adjusted analyses for age, sex, hospital type, hypertension, diabetes and additional risk factors.
Key findings
Black individuals with PE had a higher hospitalization rate (20.1 per 10,000 person-years) than white patients (13.1 per 10,000), Hispanic (6 per 10,000), Native American (5.6 per 10,000) and Asian individuals (3 per 10,000).
Compared with white individuals, members of racial and ethnic minority groups appeared less likely to be aged older than 65 years and more likely to be women, in the lowest income quartile (except for Asian/Pacific Islander individuals), have Medicaid and reside in urban neighborhoods (except for Native American individuals).
Although they had the lowest hospitalization rate for PE, Asian/Pacific Islander individuals had the highest odds of presenting with high-risk PE (OR = 1.5; 95% CI, 1.29-1.76) compared with white individuals, followed by those of other races (OR = 1.21; 95% CI, 1.05-1.4), Black individuals (OR = 1.2; 95% CI, 1.14-1.27) and Hispanic individuals (OR = 1.11; 95% CI, 1.01-1.24). Native American individuals had similar risk as white individuals.
Overall, 5.5% of hospitalized people received advanced therapy for acute PE and 19% received advanced therapy, most commonly systemic thrombolysis, for high-risk PE.
Members of racial and ethnic minority groups appeared less likely than white patients to receive advanced therapies for PE, including 13% lower odds for Black patients (OR = 0.87; 95% CI, 0.81-0.92) and 24% lower odds for Asian/Pacific Islander patients (OR = 0.76; 95% CI, 0.59-0.98). Compared with those with private insurance, individuals with Medicare had 27% lower odds of advanced therapy use (OR = 0.73; 95% CI, 0.69-0.77) and those with Medicaid had 32% lower odds (OR = 0.68; 95% CI, 0.63-0.74). Researchers observed no relationship between income level and receipt of these therapies, Cushman said.
Among all people hospitalized for PE, groups at highest risk for in-hospital mortality included Hispanic individuals (OR = 1.1; 95% CI, 1-1.22), Asian/Pacific Islander individuals (OR = 1.53; 95% CI, 1.32-1.78) and those of other races (OR = 1.34; 95% CI, 1.18-1.52) compared with white individuals, as well as those in the lowest vs. highest income quartile (OR = 1.09; 95% CI, 1.02-1.17).
Among those hospitalized with high-risk PE, all racial and ethnic minority groups had higher odds of dying in the hospital than white individuals, including Black (OR = 1.11; 95% CI, 1.01-1.23), Hispanic (OR = 1.23; 95% CI, 1.04-1.44), Asian/Pacific Islander (OR = 1.5; 95% CI, 1.18-1.92) and other-race (OR = 1.43; 95% CI, 1.18-1.92) individuals.
Researchers observed no relationship between insurance or income status and in-hospital mortality among patients with high-risk PE.
Implications, next steps
The reasons why racial and ethnic minority individuals have greater odds of high-risk PE and in-hospital mortality remain unknown, Cushman said.
“They could be rooted in structural racism, for example, and other social determinants of health that weren’t measured, such as education level and quality of education,” she said. “I think the findings really raise the importance of this research area and call for vigorous future research to try to better identify why we see these patterns and then come up with solutions to solve them.
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Farmakis I, et al. Abstract 140. Presented at: ASH Annual Meeting and Exposition; Dec. 10-13, 2022; New Orleans.
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