Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States

Abstract

Socioeconomic status (SES) as reflected by residential zip code may adversely influence outcomes for patients with acute pulmonary embolism (PE). We sought to analyze the impact of neighborhood SES on in-hospital mortality, use of thrombolysis, implantation of inferior vena cava (IVC) filters and cost of hospitalization following acute PE. We used the 2003-2011 Nationwide Inpatient Sample (NIS) for this analysis. All hospital admissions with a principal diagnosis of acute PE were identified using ICD-9 codes. Neighborhood SES was assessed using median household income of the residential zip code for each patient. Over this 9-year period, 276,484 discharges with acute PE were analyzed. There was a progressive decrease in in-hospital mortality across the SES quartiles (p-trend <0.001). The incidence of in-hospital mortality across quartiles 1-4 was 3.8%, 3.3%, 3.2%, and 3.1%, respectively. Despite low rates of thrombolytic utilization in this cohort, we observed a progressive increase in the rate of thrombolysis utilization across the SES quartiles (1.5%, 1.6%, 1.7%, 2.0%; p-trend <0.001). There was no significant difference in the use of IVC filters across the SES quartiles (p-trend=0.9). The mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1, was significantly higher by $1202, $1650, and $1844, respectively (p-trend<0.001). In conclusion, patients residing in zip codes with lower SES had increased in-hospital mortality and decreased utilization of thrombolysis following acute PE compared to patients residing in higher SES zip codes. The cost of hospitalization for patients from higher SES quartiles was significantly higher than those from lower quartiles.

Patients’ Socio-Economic Status, Tobacco and Medical History Associated with Implant Failure

“…The effect of socio-economic status in the present study was solely evaluated by neighborhood-level measures that have often been used in the literature ( 20 ). We utilized a patient’s zip code as a surrogate measure to determine individual socio-economic status, which has been validated in the past by other epidemiological investigations ( 21 , 22 ). In the present study, patients with dental insurance exhibited similar implant treatment outcomes when compared to uninsured patients.…”

Understanding Racial and Ethnic Disparities in Postsurgical Complications Occurring in U.S. Hospitals

“…) and worse health care quality and outcomes (Bikdeli et al. ; Agarwal, Menon, and Jaber ). Even though we performed risk‐adjusted analyses on both patient health and surgical quality, our measure of community income may be capturing unmeasured poor health status and health care quality of patients living in low‐income areas.…”

“…In addition, measured community-level SES may be a proxy for other factors affecting surgical complications. Low-community-level SES is often associated with lower patient health status (Cubbin, Hadden, and Winkleby 2001;Shohaimi et al 2003) and worse health care quality and outcomes (Bikdeli et al 2014;Agarwal,…”

Systemic Thrombolytic Therapy for Acute Pulmonary Embolism: Who Is a Candidate?

“…Data were retrieved from studies that investigated trends in pulmonary embolism. 19,[49][50][51][52][53][54][55][56] In case of duplicate or overlapping data, only the most recent publication was included. Pulmonary embolism was listed as the principal diagnosis in de Miguel-Díez et al, Dentali et al, Wiener et al, Shiraev et al, and Smith et al, [52][53][54][55][56] while in Jiménez et al, 19 Tsai et al, 50 and Wiener et al, 54 any listed code for pulmonary embolism was considered.…”