Disparities in access to and timing of interventional therapies for pulmonary embolism across the United States

Barret Rush; Jennifer Ziegler; Stephanie Dyck; Surinder Dhaliwal; Owen Mooney; Sylvain Lother; Leo Anthony Celi; Asher A Mendelson

doi:10.1016/j.jtha.2024.03.013

Disparities in access to and timing of interventional therapies for pulmonary embolism across the United States

J Thromb Haemost. 2024 Mar 28:S1538-7836(24)00171-5. doi: 10.1016/j.jtha.2024.03.013. Online ahead of print.

Authors

Barret Rush¹, Jennifer Ziegler², Stephanie Dyck³, Surinder Dhaliwal³, Owen Mooney², Sylvain Lother², Leo Anthony Celi⁴, Asher A Mendelson²

Affiliations

¹ Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: brush@hsc.mb.ca.
² Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Harvard Medical School, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

PMID: 38554934
DOI: 10.1016/j.jtha.2024.03.013

Abstract

Background: Interventional therapies (ITs) are an emerging treatment modality for pulmonary embolism (PE); however, the degree of racial, sex-based, and sociodemographic disparities in access and timing is unknown.

Objectives: To investigate barriers to access and timing of ITs for PE across the United States.

Methods: A retrospective cohort study utilizing the Nationwide Inpatient Sample from 2016-2020 included adult patients with PE. The use of ITs (mechanical thrombectomy and catheter-directed thrombolysis) was identified via International Classification of Diseases 10th revision codes. Early IT was defined as procedure performed within the first 2 days after admission.

Results: A total of 27 805 273 records from the 2016-2020 Nationwide Inpatient Sample database were examined. There were 387 514 (1.4%) patients with PE, with 14 249 (3.6%) of them having undergone IT procedures (11 115 catheter-directed thrombolysis, 2314 thrombectomy, and 780 both procedures). After multivariate adjustment, factors associated with less use of IT included Black race (odds ratio [OR], 0.90; 95% CI, 0.86-0.94; P < .01), Hispanic race (OR, 0.73; 95% CI, 0.68-0.79; P < .01), female sex (OR, 0.88; 95% CI, 0.85-0.91; P < .01), treatment in a rural hospital (OR, 0.49; 95% CI, 0.44-0.54; P < .01), and lack of private insurance (Medicare OR, 0.77; 95% CI, 0.73-0.80; P < .01; Medicaid OR, 0.65; 95% CI, 0.61-0.69; P < .01; no coverage OR, 0.87; 95% CI, 0.82-0.93; P < .01). Among the patients who received IT, 11 315 (79%) procedures were conducted within 2 days of admission and 2934 (21%) were delayed. Factors associated with delayed procedures included Black race (OR, 1.12; 95% CI, 1.01-1.26; P = .04), Hispanic race (OR, 1.52; 95% CI, 1.28-1.80; P < .01), weekend admission (OR, 1.37; 95% CI, 1.25-1.51; P < .01), Medicare coverage (OR, 1.24; 95% CI, 1.10-1.40; P < .01), and Medicaid coverage (OR, 1.29; 95% CI, 1.12-1.49; P < .01).

Conclusion: Significant racial, sex-based, and geographic barriers exist in overall access to IT for PE in the United States.

Keywords: USA; catheter-directed thrombolysis; disparities; interventional therapy; mechanical thrombectomy; pulmonary embolism; time to therapy.