Association Between Black Race, Clinical Severity, and Management of Acute Pulmonary Embolism: A Retrospective Cohort Study

Abstract

Background Existing evidence indicates Black patients have higher incidence of pulmonary embolism (PE) and PE‐related mortality compared with other races/ethnicities, yet disparities in presenting severity and treatment remain incompletely understood. Methods and Results We retrospectively queried a multihospital healthcare system for all hospitalizations for acute PE (2012–2019). Of 10 329 hospitalizations, 8743 met inclusion criteria. Black patients (14.3%) were significantly younger (54.6±17.8 versus 63.1±16.6 years; P <0.001) and more female (56.1% versus 51.6%; P =0.003) compared with White patients. Using ordinal regression, Black race was significantly associated with higher PE severity after matching 1:3 on age and sex (1210:3264; odds ratio [OR], 1.08; 95% CI, 1.03–1.14), adjusting for clinical (OR, 1.13; 95% CI, 1.01–1.27), and socioeconomic (OR, 1.05; 95% CI, 1.05–1.35) characteristics. Among intermediate and high‐severity PE, Black race was associated with a decreased risk of intervention controlling for the competing risk of mortality and censoring on hospital discharge. This effect was modified by PE severity ( P value <0.001), with a lower and higher risk of intervention for intermediate and high‐severity PE, respectively. Race was not associated with in‐hospital mortality (OR, 0.84; 95% CI, 0.69–1.02). Conclusions Black patients hospitalized with PE are younger with a higher severity of disease compared with White patients. Although Black patients are less likely to receive an intervention overall, this differed depending on PE severity with higher risk of intervention only for life‐threatening PE. This suggests nuanced racial disparities in management of PE and highlights the complexities of healthcare inequalities.

Population-Based Disparities in Inferior Vena Cava Filter Procedures Among Medicare Enrollees With Acute Venous Thromboembolism

“…However, other characteristics observed to be associated with IVCF placement and retrieval variability do not have clinical justification. The observed variations by geographic region and race, although consistent with what other studies have shown [17,19,20,27,28], suggest possible differences in regional clinical practice patterns and access to care. Phillips et al [28] recently observed among a cohort of patients with acute PE that Black patients presented with higher PE severity than White patients, even after matching on age and sex and adjusting for both clinical and socioeconomic factors.…”

“…The observed variations by geographic region and race, although consistent with what other studies have shown [17,19,20,27,28], suggest possible differences in regional clinical practice patterns and access to care. Phillips et al [28] recently observed among a cohort of patients with acute PE that Black patients presented with higher PE severity than White patients, even after matching on age and sex and adjusting for both clinical and socioeconomic factors. In that same study, Black patients were also less likely to receive an intervention of any kind, even after stratifying by PE severity.…”

Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina

“…1,4,8,9,51 Several studies have described differences in the frequency of adverse outcomes in Black and White patients with VTE. 52 One study reported that Black individuals with PE were more likely to present with a more clinically severe event, 53 and a second study noted that Black individuals were more likely to be hospitalized than White individuals with PE. 54 Although we did not collect information about hospitalization following a new diagnosis of PE, we did not observe a difference in the use of thrombolytic therapy or embolectomy in Black compared to White patients.…”

Clinical outcomes and echocardiographic characteristics between African American and Caucasian patients with acute pulmonary embolism

“…12 In a recent publication from a multicenter retrospective review, Phillips found that African American patients are more likely to present with higher severity of PE compared to Caucasians; African Americans were less likely to receive an intervention, but this had no impact on in-hospital mortality. 13…”