Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
Department of Vascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH.
J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101683. doi: 10.1016/j.jvsv.2023.08.022. Epub 2023 Sep 12.
We sought to determine whether racial and ethnic disparities existed in inferior vena cava (IVC) filter (IVCF) placement rates among Black and Latino patients for the treatment of acute proximal lower extremity (LE) deep vein thrombosis (DVT) in the United States from 2016 to 2019.
We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal LE DVT from January 2016 to December 2019, including self-reported patient race and ethnicity. IVCF placement rates were identified using International Classification of Diseases, 10th revision, codes. Weighted multivariable logistic regression was used to compare IVCF use by race and ethnicity. The regression model was adjusted for patient demographics (ie, sex, primary payer, quartile classification of household income), hospital information (ie, region, location, teaching status, bed size), weekend admission, and clinical characteristics (ie, modified Charlson comorbidity index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, contraindications to anticoagulation, including other major bleeding).
Of 134,499 acute proximal LE DVT patients, 18,909 (14.1%) received an IVCF. Of the patients who received an IVCF, 12,733 were White (67.3%), 3563 were Black (18.8%), and 1679 were Latino (8.9%). IVCF placement decreased for all patient groups between 2016 and 2019. After adjusting for the U.S. population distribution, the IVCF placement rates were 11 to 12/100,000 persons for Black patients, 7 to 8/100,000 persons for White patients, and 4 to 5/100,000 persons for Latino patients. The difference in IVCF placement rates was statistically significant between patient groups (Black patients vs White patients, P < .05; Black patients vs Latino patients, P < .05; Latino patients vs White patients, P < .05).
This nationwide study showed that Black patients have higher IVCF placement rates compared with White and Latino patients. Given the known long-term complications and uncertain benefits of IVCFs, coupled with the 2010 U.S. Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias might be perpetuating this disparity.
我们旨在确定在美国，2016 年至 2019 年间，在治疗急性近端下肢（LE）深静脉血栓形成（DVT）的黑人患者和拉丁裔患者中，是否存在下腔静脉滤器（IVCF）放置率的种族和民族差异。
我们对国家住院患者样本数据进行了回顾性分析，以确定 2016 年 1 月至 2019 年 12 月期间患有急性近端 LE DVT 的成年患者的主要出院诊断，包括患者自报的种族和民族。使用国际疾病分类，第 10 次修订版（ICD-10）代码确定 IVCF 放置率。使用加权多变量逻辑回归比较种族和民族的 IVCF 使用情况。回归模型调整了患者人口统计学因素（即性别、主要支付人、家庭收入四分位分类）、医院信息（即地区、位置、教学状态、床位数）、周末入院和临床特征（即改良 Charlson 合并症指数、高血压、心房颤动、2 型糖尿病、充血性心力衰竭、血脂异常、冠心病、吸烟、肥胖、酒精滥用、慢性肾脏病、肺栓塞、恶性肿瘤、抗凝禁忌，包括其他大出血）。
在 134499 例急性近端 LE DVT 患者中，18909 例（14.1%）接受了 IVCF。在接受 IVCF 的患者中，12733 例为白人（67.3%），3563 例为黑人（18.8%），1679 例为拉丁裔（8.9%）。2016 年至 2019 年间，所有患者群体的 IVCF 放置率均下降。在美国人口分布调整后，黑人患者的 IVCF 放置率为 11 至 12/10 万，白人患者为 7 至 8/10 万，拉丁裔患者为 4 至 5/10 万。患者群体之间的 IVCF 放置率差异具有统计学意义（黑人患者与白人患者相比，P<.05；黑人患者与拉丁裔患者相比，P<.05；拉丁裔患者与白人患者相比，P<.05）。
这项全国性研究表明，与白人患者和拉丁裔患者相比，黑人患者的 IVCF 放置率更高。鉴于已知的 IVCF 长期并发症和不确定的获益，再加上 2010 年美国食品和药物管理局（FDA）对这些设备不良患者事件的安全警告，应采取积极措施解决黑人患者群体中的这一差异，以促进健康公平。未来的工作应评估临床医生的偏见是否会加剧这种差异。
