Social determinants of health in pulmonary embolism management and outcome in hospitals: Insights from the United States nationwide inpatient sample

Farmakis, Ioannis; Valerio, Luca; Giannakoulas, George; Hobohm, Lukas; Cushman, Mary; Piazza, Gregory; Konstantinides, Stavros

doi:10.1016/j.rpth.2023.100147

Cited by 16 publications

(9 citation statements)

References 27 publications

(28 reference statements)

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“…Epidemiological data from the United States reveal geographic, racial, age, and sex disparities in the age‐adjusted mortality rate due to PE, suggesting that this increased risk may be modifiable 2,3,6,8 . Farmakis et al 9 . recently demonstrated socioeconomic and geographic disparities in accessing advanced PE therapies (systemic thrombolysis, catheter‐directed thrombolysis [CDT], thrombectomy, extracorporeal membrane oxygenation) in large U.S. populations.…”

Section: An Increasing Pe‐related Mortality Trendmentioning

confidence: 99%

“…Increased PE mortality in younger U.S. patients is paradoxical 6,8,10 . Suggested explanations include an increasing prevalence of obesity, 11 gastrointestinal cancers, 8,12 behavioral risk factors, 8 health care inequalities, 3,9 and U.S. medical care price inflation 6 …”

Section: An Increasing Pe‐related Mortality Trendmentioning

confidence: 99%

“…One systematic review found PERTs were associated with increased use of advanced therapies and were broadly supported among physicians who manage patients with acute PE 39 . PERT consultation delivered by telemedicine could be offered to medically underserved areas to address disparities in advanced therapy utilization 9 . Financial incentives to create PERTs should be initiated and research investigating the effect of PERTs on patient outcomes, length of hospital stay, and total hospital expenditures may provide needed financial justification 40 …”

Section: Improving Outcomes For Patients With High‐risk Pementioning

confidence: 99%

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Addressing the rising trend of high‐risk pulmonary embolism mortality: Clinical and research priorities

Casey,

Stubblefield,

Luijten

et al. 2024

Academic Emergency Medicine

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Deaths from high‐risk pulmonary embolism (PE) appear to have increased in the last decade. Modifiable risks contributing to this worrisome trend present opportunities for physicians, researchers, and healthcare policymakers to reduce excess mortality. Emerging advanced therapies for PE appear promising, although we lack clear insight as to the magnitude of potential benefit and which patient subgroup(s) should receive them. Treatment and outcome disparities attributable to social determinants of health demand new healthcare delivery policy. In this article, we examine current PE epidemiology, suggest quality improvement and healthcare policy initiatives, and discuss relevant ongoing clinical trials aimed at addressing excess PE mortality.

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Section: An Increasing Pe‐related Mortality Trendmentioning

confidence: 99%

Section: An Increasing Pe‐related Mortality Trendmentioning

confidence: 99%

Section: Improving Outcomes For Patients With High‐risk Pementioning

confidence: 99%

See 1 more Smart Citation

Addressing the rising trend of high‐risk pulmonary embolism mortality: Clinical and research priorities

Casey,

Stubblefield,

Luijten

et al. 2024

Academic Emergency Medicine

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“…Racial and ethnic disparities are known to influence the outcomes of patients hospitalized with a diverse array of conditions [ 9 – 13 ]. Among patients hospitalized with acute PE, race and ethnicity have also been demonstrated to have an impact on overall outcomes [ 14 – 16 ]. However, whether the implementation of PERT-based care for patients with acute PE mitigates these racial and ethnic disparities remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Rehman,

Singh,

Sridhar

et al. 2024

Respir Res

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Background Management of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT. Methods We performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes. Results Median age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different. Conclusion Within a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.

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“…Equal in both impact and concern, this study shows a higher mortality for Black Americans compared with White Americans, reinforcing prior findings ( 8 ). Prior work using the National Inpatient Sample as well as Medicare databases has suggested that persons of color and socioeconomically disadvantaged or uninsured Americans are less likely to be treated with advanced therapies for pulmonary embolism ( 10 – 12 ). Although racial disparities are generally well recognized in interhospital transfer, to our knowledge, no specific literature has described whether Black Americans lack access or are less likely to be transferred for more of these advanced therapies for pulmonary embolism.…”

mentioning

confidence: 99%

Unchanging Mortality from Pulmonary Embolism in the United States

Sung,

Kline

2023

Annals ATS

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Social determinants of health in pulmonary embolism management and outcome in hospitals: Insights from the United States nationwide inpatient sample

Cited by 16 publications

References 27 publications

Addressing the rising trend of high‐risk pulmonary embolism mortality: Clinical and research priorities

Addressing the rising trend of high‐risk pulmonary embolism mortality: Clinical and research priorities

Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study

Unchanging Mortality from Pulmonary Embolism in the United States

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