Association Between Black Race, Clinical Severity, and Management of Acute Pulmonary Embolism: A Retrospective Cohort Study

Figures

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  Figure 1. Study cohort. *Patients with pertinent medical history required for pulmonary embolism severity classification (ie, congestive heart failure, chronic pulmonary obstructive disease, and cancer; n=1200) and race categorization (n=3) were excluded. †Seven hospitals within the healthcare system had <100 admissions for pulmonary embolism throughout the study duration. ‡3.2% (n=6) of hospitalizations for Black patients and 14.1% (n=158) of hospitalizations for White patients occurred at a hospital with <100 admissions (P<0.001). 3.2% (n=6) of hospitalizations for Black patients and 2.9% (n=32) of hospitalizations for White patients were transferred to an alternative healthcare system (P=0.790). And 10.7% (n=20) of hospitalizations for Black patients and 9.0% (n=101) of hospitalizations for White patients had a repeat admission within <30 days (P=0.461). §For the 39 patients were admitted and diagnosed with a pulmonary embolism at a small, nonteaching hospital and transferred (<24 hours between admissions) within the healthcare network and admitted to a large, urban, tertiary‐care teaching hospital for definitive care, only the final treating hospital admission was included in the…

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  Figure 2. Age of hospitalization for pulmonary embolism by age, per classification for severity in the full cohort. A, Overall, Black patients (red) are hospitalized for pulmonary embolism younger than White (gray) patients. B, These patterns are consistently observed for hospitalizations for low (top), intermediate (middle), and high (bottom) severity pulmonary embolism. PE indicates pulmonary embolism.

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  Figure 3. Risk of pulmonary embolism severity risk among subgroups in the matched cohort. *P value of the interaction term. The dashed line corresponds to an OR of 1. The red line and the gray triangle corresponding to the overall OR and 95% CI for Black race in the matched cohort. Postoperative within 90 days of admission date. BMI indicates body mass index; OR, odds ratio; and PE, pulmonary embolism.

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  Figure 4. Cumulative hazard of the risk of in‐hospital procedures overall among intermediate and high‐severity pulmonary embolisms in the matched cohort together (A) and separately (B and C). Cumulative hazard curves demonstrate the risk of any intervention in the combined high‐ and intermediate severity pulmonary embolisms (A), intermediate severity only (B), and high severity only (C) adjusting for the competing risk of mortality, clustering by hospital size, and censoring for hospital discharge in the matched cohort (risk tables). A, Black (light gray) patients hospitalized with intermediate or high‐severity pulmonary embolism have a lower relative risk of undergoing any interventions when compared with White (dark gray) patients. The association between receipt of therapy and race differed between intermediate and high‐severity subgroups (P value of interaction, <0.001; B, Risk of intervention for intermediate severity pulmonary embolism. C, Risk of intervention for high‐severity pulmonary embolism).