Hispanic patients with PAH have more ED visits, hospitalizations but no survival difference

Hispanic ethnicity was not associated with survival differences in pulmonary arterial hypertension despite a “disadvantageous social determinants of health profile,” researchers reported in the Annals of the American Thoracic Society.

“While recent studies describing the association between race, ethnicity and clinical outcomes in PAH have suggested that Hispanic ethnicity was associated with a lower risk of mortality, these studies did not account for sociocultural factors or social determinants of health,” Vinicio de Jesus Perez, MD, associate professor of medicine in the division of pulmonary and critical care medicine and the Vera Moulton Wall Center for Pulmonary Disease at Stanford University, told Healio. “It remained unknown how social determinants of health differed between racial or ethnic groups in patients with PAH. Furthermore, the association between Hispanic ethnicity and clinical outcomes in PAH, after adjusting for social determinants of health, had not been explored.”

The researchers conducted a prospective cohort study that included 683 adults with PAH who were enrolled in the Pulmonary Hypertension Association Registry. All participants were classified as Hispanic or non-Hispanic white individuals based on self-reported ethnicity. Researchers compared baseline clinical and sociodemographic characteristics between the two groups.

The primary outcome was transplant-free survival.

Ninety-eight individuals were Hispanic (mean age, 43.2 years; 78.6% women) and 585 were non-Hispanic white (mean age, 57.9 years; 75.4% women). A larger proportion of Hispanic patients had impaired access to health care (31.6% vs. 12.9%), lower educational level (72.6% vs. 94%) and lower annual income (32% vs. 17.4%) compared with non-Hispanic white patients.

Hispanic patients had a higher frequency of visits to the ED (incidence rate ratio [IRR] = 1.452; 95% CI, 1.326-1.59) and hospitalizations (IRR = 1.428; 95% CI, 1.292-1.577) compared with non-Hispanic white patients, despite similar disease severity, according to the researchers.

Hispanic patients had lower risk for transplant/death in unadjusted analyses (HR = 0.47; 95% CI, 0.24-0.94; P = .032). The researchers reported no association between Hispanic ethnicity and transplant-free survival after adjusting for social determinants of health and other factors (HR = 0.76; 95% CI, 0.35-1.62; P = .474).

“Hispanic patients had a higher frequency of ED visits and a higher number of hospitalizations, despite having similar functional class, PAH risk severity, exercise capacity, natriuretic peptide levels and/or PAH-specific therapy. Yet, socioeconomic factors and social determinants of health were significantly different in the Hispanic population; Hispanic patients had less optimal health care insurance, lower annual income, lower education level and were more likely to be unemployed as compared with non-Hispanic white patients,” de Jesus Perez said. “While it is plausible that Hispanics could have inherent factors offering a survival advantage, this potential protective effect may lose its effect if other factors such as social disadvantage and unfavorable social determinants of health coexist.”

The researchers noted several limitations of the current study, including its small sample size despite a larger proportion of Hispanic participants than other PAH registries.

“Larger sample size and access to data from patients being treated outside pulmonary hypertension centers of excellence will help address how generalizable our findings are to the Hispanic population,” de Jesus Perez said.

For more information:

Vinicio de Jesus Perez, MD, can be reached at vdejesus@stanford.edu.