乌鸦传媒

NEW ORLEANS -- Black individuals in the U.S. face a disproportionate burden of hospitalization from pulmonary embolism (PE), yet are less likely to receive advanced therapies for PE, a large analysis of hospital data revealed.

Among more than 1 million hospitalizations for PE from 2016 to 2018, rates were highest among Black people (20.1 per 10,000 adults each year), reported Mary Cushman, MD, MSc, of the Larner College of Medicine at the University of Vermont in Burlington, at the American Society of Hematology annual meeting.

But compared with white individuals, the use of advanced therapies was 13% lower among Black patients (OR 0.87, 95% CI 0.81-0.92) and 24% lower among Asian/Pacific Islander patients (OR 0.76, 95% CI 0.59-0.98).

Meanwhile, those enrolled in Medicare were 27% less likely to receive advanced therapies (OR 0.73, 95% CI 0.68-0.77) compared with people on private insurance, while those on Medicaid were 32% less likely (OR 0.68, 95% CI 0.64-0.74).

"Disparities in the use of advanced therapies could relate to modifiable factors like racism or constraints imposed by insurance status," Cushman said during a press briefing. "The reasons for all these findings are unknown, and they could be rooted in structural racism, for example, and other social determinants of health that weren't measured."

In-hospital mortality after PE was 10% to 53% higher among Hispanic people, Asian/Pacific Islanders, and people of other racial or ethnic groups compared with white people. In the case of high-risk PE, all racial and ethnic groups saw higher in-hospital mortality compared with white individuals, with ORs ranging from 1.11 (95% CI 1.01-1.23) for Black individuals to 1.50 (95% CI 1.18-1.92) for Asian/Pacific Islanders.

Reasons that racial and ethnic minority patients are more likely to present with high-risk PE are unknown, said Cushman, but several factors could be at play, including differences in awareness of PE symptoms, less trust in the healthcare system leading to delayed care, or misdiagnosis.

The retrospective study looked at 1,124,204 individuals hospitalized with a primary diagnosis of PE from 2016 to 2018 in the Nationwide Inpatient Sample, which captures 20% of discharges from U.S. hospitals. Of these, 66,570 cases were considered high-risk, as defined by certain indicators of severity: shock, cardiac arrest, or use of vasopressors or ventilation. Advanced therapies included systemic thrombolysis, catheter-directed therapy, surgical embolectomy, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Overall, the rate of hospitalization for PE was 14.1 per 100,000 individuals per year. After Black individuals, rates per 100,000 were next highest among white individuals (13.1), followed by Hispanic (6), Native-American (5.6), and Asian (3.0) individuals.

White individuals presenting with PE tended to be older and were more likely to be male, while Black, Hispanic, and Asian/Pacific Islander groups were more likely to be on Medicaid, more likely to live in urban areas, and more likely to have a lower income.

Advanced or more aggressive therapies were used in 5.5% of hospitalizations for acute PE, including 19% of hospitalizations for high-risk PE. Systemic thrombolysis was used most frequently (13% of high-risk cases and 2.4% of all cases), followed by inferior vena cava filter (12% and 7%, respectively), catheter-directed therapy (4.4% and 2.1%), VA-ECMO (2.5% and 0.1%), and surgical embolectomy (1.5% and 0.1%).

Analyses for high-risk PE were adjusted for primary diagnosis, sex, age, rural or urban location, income, insurance type, hospital size or type, and a history of hypertension or diabetes. Analyses looking at use of advanced therapies were adjusted for a host of other factors.

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