Socioeconomic Disparities in the Care of for High-Risk Pulmonary Embolism in the United States, 2016 to 2020

Authors

Apoorva Doshi, Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
Prakash Upreti, Rochester Regional HealthFollow
Vikas Aggarwal, Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, Michigan.
Athena Poppas, Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown University Health Cardiovascular Institute, Providence, Rhode Island.
Peter A. Soukas, Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown University Health Cardiovascular Institute, Providence, Rhode Island.
J Dawn Abbott, Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown University Health Cardiovascular Institute, Providence, Rhode Island.
Saraschandra Vallabhajosyula, Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Brown University Health Cardiovascular Institute, Providence, Rhode Island.

Department

Medicine

Document Type

Article

Publication Title

The American Journal of Cardiology

Abstract

There are limited data on the impact of socioeconomic factors on the management and outcomes of high-risk acute pulmonary embolism (PE). Using the National Inpatient Sample (NIS) from 2016 to 2020, we identified adult (≥ 18 years) admissions with high-risk PE (defined as PE with one of: cardiogenic shock, vasopressor use, or cardiac arrest). Socioeconomic determinants included sex, race, insurance payer, and economic status. Outcomes of interest included in-hospital mortality, rates of mechanical circulatory support (MCS) and definitive PE interventions, hospitalization duration, and hospitalization costs. Among 21,521 high-risk PE hospitalizations (median age 65 years, 53% male, 64% white race), the socioeconomic variables remained stable during the 5-year period. MCS utilization was 4%, with lower rates of utilization in Medicare and Medicaid beneficiaries, uninsured admissions, and those from the lowest income quartile (all p < 0.05). Racial minorities, those from lower economic status, and uninsured admissions received advanced PE interventions less frequently. There did not appear to be notable sex disparities in use of advanced PE therapies. Overall, in-hospital mortality was 50%, with higher adjusted in-hospital mortality in female, African American, Hispanic, uninsured, and economically disadvantaged individuals. In conclusion, significant inequities in in-hospital mortality, mechanical circulatory support, and definitive pulmonary embolism therapy utilization persist among high-risk PE hospitalizations in the United States based on sex, race, income, and insurance status.

First Page

61

Last Page

69

DOI

10.1016/j.amjcard.2025.05.003

Volume

250

Publication Date

9-1-2025

Medical Subject Headings

Humans; Pulmonary Embolism (therapy, epidemiology, economics, mortality); Male; United States (epidemiology); Female; Aged; Healthcare Disparities (statistics & numerical data); Hospital Mortality (trends); Middle Aged; Socioeconomic Factors; Hospitalization (statistics & numerical data, economics); Medicaid; Risk Factors; Medicare; Retrospective Studies; Adult; Socioeconomic Disparities in Health

PubMed ID

40348044

Recommended Citation

Doshi, A., Upreti, P., Aggarwal, V., Poppas, A., Soukas, P. A., Abbott, J. D., & Vallabhajosyula, S. (2025). Socioeconomic Disparities in the Care of for High-Risk Pulmonary Embolism in the United States, 2016 to 2020. The American Journal of Cardiology, 250, 61-69. https://doi.org/10.1016/j.amjcard.2025.05.003