F-20 | Regional Disparities in Pulmonary Embolism Outcomes: A 5-Year United States Study

There are limited data on the hospital-level outcomes of patients with pulmonary embolism (PE) based on the hospital location in the United States (US). All adult (>18 years) non-elective admissions with a primary diagnosis of PE, admitted to Northeast (NE), Midwest (MW), South (S), and West (W) US geographic regions were identified using the National Inpatient Sample (2016-2020). The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay and hospitalization costs. During 01/01/2016 to 12/31/2020, 904,259 PE admissions were identified. NE, MW, S, and W geographic regions had 18.3%, 24.9%, 38.7% and 17.9% of the admissions respectively. Compared to South, other regions had higher rates of admissions of white race (NE 71.5%, MW 75.4%, W 70.3%, S 63.7%), with higher socioeconomic status (NE 31.9%, MW 16.1%, W 27.0%, S 14.3%), and higher rates of Medicare admissions (NE 51.1%, MW 54.1%, W 52.5%, S 50.7% (all p<0.001). Western region had lowest rates of females (NE 53.1%, MW 51.7%, W 49.1%, S 52.3%) and admissions to small size hospitals (NE 25.1%, MW 23.3%, W 18.1%, S 19.5%). Western region also had higher rates of respiratory failure (NE 20.9%, MW 27.5%, W 32.7%, S 25.1% ) and renal failure (NE 12.9%, MW 13.6%, W14.6%, S 14.1%) compared to other regions (all p<0.001). In Northeastern areas compared to other regions, use of catheter-directed thrombolytics (NE 2.8%, MW 3.7%, W 3.7%, S 4.1%), systemic thrombolysis (NE 2.8%, MW 3.0%, W 3.0%, S 3.4%), mechanical thrombectomy (NE 0.9%, MW 1.5%, W 1.4%, S 1.3%), pulmonary artery catheter insertion (NE 0.1%, MW 0.2%, W 0.2%, S 0.3%) invasive mechanical ventilation (NE 2.9%, MW 3.2%, W 3.4%, S 3.5%) were the lowest (all p<0.005). Midwestern regions had lowest rates of unadjusted in-hospital mortality (NE 3.1%, MW 2.8%, W 3.3%, S 3.2%), total hospitalization costs (NE $52990, MW $40697, W 63070, S $48875), and shorter hospital stays (in days) (NE 4.5, MW 4.1, S 4.34, W 4.0) (all p<0.001). In this five-year study duration, although PE admissions to MW had increased comorbidities and lower socio-economic status, they had higher rates of interventions and better outcomes. There exist significant disparities in management and outcomes of PE.