Black race was associated with higher acute pulmonary embolism severity (OR 1.08; 95% CI 1.03-1.14) compared with White patients, but not with in-hospital mortality.
Cohort (n=8,743)
Yes
Is Black race associated with differences in clinical severity, management, and mortality in patients with acute pulmonary embolism compared to White race?
Black patients presenting with acute pulmonary embolism are younger and have higher disease severity compared to White patients, with nuanced disparities in the likelihood of receiving interventions based on severity.
Odds Ratio: 1.08 (95% CI 1.03–1.14)
Background Existing evidence indicates Black patients have higher incidence of pulmonary embolism (PE) and PE‐related mortality compared with other races/ethnicities, yet disparities in presenting severity and treatment remain incompletely understood. Methods and Results We retrospectively queried a multihospital healthcare system for all hospitalizations for acute PE (2012–2019). Of 10 329 hospitalizations, 8743 met inclusion criteria. Black patients (14.3%) were significantly younger (54.6±17.8 versus 63.1±16.6 years; P <0.001) and more female (56.1% versus 51.6%; P =0.003) compared with White patients. Using ordinal regression, Black race was significantly associated with higher PE severity after matching 1:3 on age and sex (1210:3264; odds ratio OR, 1.08; 95% CI, 1.03–1.14), adjusting for clinical (OR, 1.13; 95% CI, 1.01–1.27), and socioeconomic (OR, 1.05; 95% CI, 1.05–1.35) characteristics. Among intermediate and high‐severity PE, Black race was associated with a decreased risk of intervention controlling for the competing risk of mortality and censoring on hospital discharge. This effect was modified by PE severity ( P value <0.001), with a lower and higher risk of intervention for intermediate and high‐severity PE, respectively. Race was not associated with in‐hospital mortality (OR, 0.84; 95% CI, 0.69–1.02). Conclusions Black patients hospitalized with PE are younger with a higher severity of disease compared with White patients. Although Black patients are less likely to receive an intervention overall, this differed depending on PE severity with higher risk of intervention only for life‐threatening PE. This suggests nuanced racial disparities in management of PE and highlights the complexities of healthcare inequalities.
Phillips et al. (2021) conducted a cohort in acute pulmonary embolism (n=8,743). Black race vs. White race was evaluated on higher PE severity (OR 1.08, 95% CI 1.03-1.14). Black race was associated with higher acute pulmonary embolism severity (OR 1.08; 95% CI 1.03-1.14) compared with White patients, but not with in-hospital mortality.