Key result
Lower household income (< $20,000 vs ≥ $100,000) was associated with increased time-to-treatment for pulmonary arterial hypertension (HR 0.74; 95% CI 0.60-0.91).
Why the study?
Prompt therapy initiation after PAH diagnosis improves outcomes, but treatment delays are common and it is incompletely understood whether worse outcomes in socially disadvantaged groups are mediated by care delays.
Does socioeconomic disadvantage increase time-to-treatment in Veterans with incident pulmonary arterial hypertension?
Cohort (n=1,827)
Does socioeconomic disadvantage increase time-to-treatment in Veterans with incident pulmonary arterial hypertension?
Socioeconomically disadvantaged Veterans with PAH, specifically those with lower income and without non-VA insurance, experience significant delays in receiving PAH-specific therapy.
Prompt initiation of therapy after pulmonary arterial hypertension (PAH) diagnosis is critical to improve outcomes; yet delays in PAH treatment are common. Prior research demonstrates that individuals with PAH belonging to socially disadvantaged groups experience worse clinical outcomes. Whether these poor outcomes are mediated by delays in care or other factors is incompletely understood. We sought to examine the association between race/ethnicity and socioeconomic status and time-to-PAH treatment. We conducted a retrospective cohort study of Veterans diagnosed with incident PAH between 2006 and 2019 and treated with PAH therapy. Our outcome was time-to-PAH treatment. Our primary exposures were race/ethnicity, annual household income, health insurance status, education, and housing insecurity. We calculated time-to-treatment using multivariable mixed-effects Cox proportional hazard models. Of 1827 Veterans with PAH, 27% were Black, 4% were Hispanic, 22.1% had an income < $20,000, 53.3% lacked non-VA insurance, 25.5% had <high school education, and 3.9% had housing insecurity. Median time-to-treatment was 114 days (interquartile range [IQR] 21-336). Our multivariable models demonstrated increased time-to-treatment among patients with lower household income (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.60-0.91 for < $20,000 vs. ≥ $100,000) and those without non-VA insurance (HR 0.90, 95% CI 0.82-1.00). Race/ethnicity, education, and housing insecurity were not associated with time-to-treatment. Veterans with PAH experienced substantial and potentially harmful treatment delays, with median time-to-treatment of 16 weeks after diagnosis. Those with lower income and those without non-VA health insurance experienced even greater treatment delays. Additional research is urgently needed to develop interventions to improve timely PAH treatment and mitigate economic disparities in treatment.
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Gillmeyer et al. (2022) conducted a cohort in pulmonary arterial hypertension (n=1,827). Lower household income (< $20,000) vs. Household income ≥ $100,000 was evaluated on time-to-PAH treatment (HR 0.74, 95% CI 0.60-0.91). Lower household income (< $20,000 vs ≥ $100,000) was associated with increased time-to-treatment for pulmonary arterial hypertension (HR 0.74; 95% CI 0.60-0.91).
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