Doshi Apoorva, Upreti Prakash, Aggarwal Vikas, Poppas Athena, Soukas Peter A, Abbott J Dawn, Vallabhajosyula Saraschandra
Institute of Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, New York.
Am J Cardiol. 2025 Sep 1;250:61-69. doi: 10.1016/j.amjcard.2025.05.003. Epub 2025 May 28.
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.
关于社会经济因素对高危急性肺栓塞（PE）管理及预后影响的数据有限。利用2016年至2020年的全国住院患者样本（NIS），我们确定了高危PE的成年（≥18岁）住院患者（定义为伴有以下情况之一的PE：心源性休克、使用血管升压药或心脏骤停）。社会经济决定因素包括性别、种族、保险支付方和经济状况。感兴趣的结局包括住院死亡率、机械循环支持（MCS）率和确定性PE干预措施、住院时间和住院费用。在21521例高危PE住院病例中（中位年龄65岁，53%为男性，64%为白人），社会经济变量在5年期间保持稳定。MCS使用率为4%，医疗保险和医疗补助受益患者、未参保住院患者以及收入最低四分位数患者的使用率较低（均p<0.05）。少数族裔、经济地位较低者以及未参保住院患者接受高级PE干预的频率较低。在使用高级PE治疗方面似乎没有明显的性别差异。总体而言，住院死亡率为50%，女性、非裔美国人、西班牙裔、未参保者以及经济弱势个体的校正住院死亡率较高。总之，在美国高危PE住院病例中，基于性别、种族、收入和保险状况，住院死亡率、机械循环支持和确定性肺栓塞治疗的使用存在显著不平等。
