Social Determinants of Health Found to Affect In-Hospital Mortality Rates From Pulmonary Embolism

Among patients hospitalized with acute pulmonary embolism (PE), non-White patients received less advanced therapies and had higher in-house mortalities compared to White patients, according to investigators presenting a poster titled “Social Determinants of Health [SDOH] and Pulmonary Embolism Treatment and Mortality: The Nationwide Inpatient Sample” at the 64th American Society of Hematology (ASH) Annual Meeting and Exhibition in New Orleans, Louisiana.

Trial investigator Mary Cushman, MD, a hematologist and medical director of the Thrombosis and Hemostasis Program and a professor of medicine and pathology at the Larner College of Medicine at the University of Vermont in Colchester, Vermont, presents the study findings at the ASH Annual Meeting and Exhibition.

“The groups at highest risk of dying in the hospital were Hispanic individuals, Pacific Islanders, and people of other races,” said Cushman during a press briefing. “They had between a 10% to 53% greater odds of dying in the hospital.”

Cushman explained further that socioeconomic status, race, and ethnicity are all SDOH that, in the United States, can contribute to increased adverse health outcomes and mortality.

To understand the impact of SDOH on the treatment of patients, investigators studied the associations between hospital management, in-hospital mortality, and their relationship with SDOH, including race and ethnicity, type of primary payer, income, and type of advanced therapy given.

Drawing from the Nationwide Inpatient Sample, investigators identified 1,124,204 adults hospitalized with a discharge diagnosis of acute PE. A subgroup of PE patients was considered high-risk based on criteria for shock, ventilator support, cardiac arrect, cardiopulmonary resuscitation, or use of vasopressor.

The data first showed that hospitalizations among Black patients with acute PE were 6-times higher than those among Asian patients who were hospitalized. For every 10,000 patients hospitalized with acute PE, risk increased across race and ethnic group—3 out of every 10,000 Asian patients were hospitalized; as were 5.6 out of 10,000 Native Americans; 6 out of 10,000 Hispanic patients; 13.1 out of 10,000 White patients; and 20.1 out of 10,000 Black patients. The data showed that cumulatively, mortality rates for high-risk Black, Hispanic, and Asian patients were 50% higher than for high-risk White patients.

In the acute PE patient population (of which 5.5% received advanced PE therapy such as thrombolysis, catheter directed treatment, surgical embolectomy, and/or extracorporeal membrane oxygenation), Black patients were 13% less likely to get advanced therapy than White patients. This rate was nearly doubled for Asian and Pacific Islander patients at 24%.

“And all of the race/ethnic groups compared to all of the White people were less likely to be above the age of 65,” Cushman added. “These are younger people coming in with this illness.”

Furthermore, Cushman noted that among the 6.4% of patients who died in-hospital, Asian patients had the highest individual risk at 50%; Hispanic patient mortality risk followed at 10%. Association between health insurance and advanced care mirrored the inequitable trends seen with use of advanced PE therapy in different races/ethnicities.

Medicare-insured patients were also less likely to receive advanced treatment (27%). Additionally, patients on Medicaid were 32% less likely to receive advanced treatment, and uninsured (along with “other-insured”) patients were 14% less likely to received advanced PE therapy.

“I think the findings really raise the importance of this research area and call for vigorous future research,” Cushman said.

Reference

Farmakis I, Cushman M, Valerio L, et al. Social Determinants of Health and Pulmonary Embolism Treatment and Mortality: The Nationwide Inpatient Sample. Presented at: 64th American Society of Hematology Annual Meeting and Exposition; December 10, 2022; New Orleans, LA. Accessed on December 10, 2022.