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

BACKGROUND: The role of social determinants in the treatment and course of acute pulmonary embolism (PE) is understudied. OBJECTIVE: To investigate the association between social determinants of health with in-hospital management and early clinical outcomes following acute PE. METHODS: We identified hospitalizations of adults with acute PE discharge diagnosis from the nationwide inpatient sample (2016-2018). Multivariable regression was used to investigate the association between race/ethnicity, type of expected primary payer, and income with the use of advanced PE therapies (thrombolysis, catheter-directed treatment, surgical embolectomy, extracorporeal membrane oxygenation), length of stay, hospitalization charges, and in-hospital death. RESULTS: A total of 1,124,204 hospitalizations with a PE diagnosis were estimated from the 2016–2018 nationwide inpatient sample, corresponding to a hospitalization rate of 14.9/10,000 adult persons-year. The use of advanced therapies was lower in Black and Asian/Pacific Islander (vs. White patients: adjusted odds ratio [OR(adjusted)], 0.87; 95% confidence interval [CI], 0.81–0.92 and OR(adjusted) 0.76; 95% CI, 0.59–0.98) and in Medicare- or Medicaid-insured (vs. privately-insured; OR(adjusted), 0.73; 95% CI, 0.69–0.77 and OR(adjusted), 0.68; 95% CI, 0.63–0.74), although they had the greatest length of stay and hospitalization charges. In-hospital mortality was higher in the lowest income quartile (vs. highest quartile; OR(adjusted), 1.09; 95% CI, 1.02–1.17). Among high-risk PE, patients of other than the White race had the highest in-hospital mortality. CONCLUSION: We observed inequalities in advanced therapies used for acute PE and higher in-hospital mortality in races other than White. Low socioeconomic status was also associated with lesser use of advanced treatment modalities and greater in-hospital mortality. Future studies should further explore and consider the long-term impact of social inequities in PE management.