December 20, 2022 by
Racial minorities and people with lower incomes or who are insured by Medicare or Medicaid are significantly less likely to receive the most advanced therapies and more likely to die after suffering a pulmonary embolism, according to a new analysis conducted by University of Vermont Professor of Medicine Mary Cushman, M.D., M.Sc., and colleagues.
Image depicts a blood clot (AdobeStock)
Racial minorities and people with lower incomes or who are insured by Medicare or Medicaid are significantly less likely to receive the most advanced therapies and more likely to die after suffering a pulmonary embolism (PE), according to a new analysis. A PE occurs when a blood clot blocks an artery in the lung, typically leading to chest pain and shortness of breath. It is a medical emergency that without timely treatment – medications or procedures to remove the clot – can cause death.
The study, based on data from more than 1 million patients in the United States, found that 6.4 percent of those hospitalized for PE died of the condition, a strikingly high case-fatality rate that further underscores the urgency of reducing disparities and improving access to care, according to researchers.
“In order to solve the disparities we see, we need to shine a light on them,” said Mary Cushman, M.D., M.Sc., professor of medicine at the Larner College of Medicine at the University of Vermont, who presented the study findings at the 64th American Society for Hematology (ASH) Annual Meeting and Exposition in New Orleans, La., on December 10, 2022. “Many people die of pulmonary embolism every year,” added Cushman, who directs the Thrombosis and Hemostasis Program at University of Vermont Medical Center, where patients with PE receive care. “[PE] is preventable and it’s certainly treatable – we need to think about what we can do in hospitals to make sure that care is equitable,” Cushman said.
The researchers analyzed records from more than 1.1 million people hospitalized with PE from 2016 to 2018, including about 66,000 with the most severe form of PE. They first analyzed which patients received advanced therapies, such as the use of a heart-lung machine or treatments in which doctors use a catheter or surgical intervention to break up the clot. They then assessed rates of in-hospital death from PE. For both analyses, researchers adjusted for hospital type, age, sex, and other risk factors to assess the influence of race, income, or insurance type independent of other factors.
Among people with the most severe PE, researchers found that Black, Hispanic, and Asian patients were significantly more likely to die than white patients. Among all racial groups, the overall rate of PE was lowest among Asian people, but Asian patients were 24 percent less likely to receive advanced therapies and 50 percent more likely to die compared with white patients. Black patients with high-risk PE were 13 percent less likely to receive advanced therapies compared with white patients, and 11 percent more likely to die. Hispanic patients were 10% more likely to die than white patients. People insured by Medicare or Medicaid were around 30% less likely to receive advanced therapies than privately insured people, and people in the lowest quartile for income were 9 percent more likely to die than people in the highest quartile for income.
Researchers say urgent attention is needed to better understand how factors such as structural racism and socioeconomic constraints may affect a person’s access, ability, and willingness to seek care, as well as clinical decision-making once patients arrive at the hospital.
“I hope that clinicians will think about these findings in terms of how they take care of patients every day, and try their best to recognize their unconscious biases,” said Cushman, who is co-director of the Vermont Center for Cardiovascular and Brain Health. “Clinicians need to look at the patient in front of them and remember that regardless of their social class or the color of their skin, they should be treated the same as everybody else.”
Link to the abstract paper featured in Cushman’s presentation, titled "Social Determinants of Health and Pulmonary Embolism Treatment and Mortality: The Nationwide Inpatient Sample."
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(This article was adapted from a press release produced by ASH Communications.)