VESS11 - Socioeconomic Disadvantage is Associated with Healthcare Disparities in Mortality and Readmissions Following Submassive (Intermediate-Risk) Pulmonary Embolism

Objectives: Submassive pulmonary embolism (sPE) can result in increased morbidity and mortality but the impact of socio-economic status (SES) on outcomes has not been explored. We investigated this association using the Area Deprivation Index (ADI), a validated measure of SES.

Methods: Patients admitted with sPE (2013-2019) at one multi-hospital healthcare network were divided into terciles by ADI. A higher ADI indicates poor SES. To establish a cohort of patients with a prolonged life expectancy, patients younger than 60 were included and those with a diagnosis of cancer were excluded. Outcomes included overall and cardiovascular/PE-related mortality and readmission for thromboembolic event (VTE), heart failure exacerbation, or myocardial infarction (MI) at 3 months, 1 and 5 years. After excluding patients who died before hospital discharge, groups were compared using Kaplan-Meier survival curves, log-rank testing, and multivariable Cox-proportional models. To assess morbidity, sub-analysis of patients from 2013 to 2015 was conducted using hospitalization for VTE, heart failure, or MI as an endpoint.

Results: Of 8,761 PE hospitalizations, 2,021 patients met the selection criteria. Patients in higher ADI terciles were more likely to be younger, female, Black race, and smokers (p < 0.001) with a greater incidence of co-morbidities (p < 0.05) (Table 1). Compared with the least deprived tercile, patients in the most deprived tercile had worse survival at 3 months (99.43% vs 98.21%, aHR=3.59, 95%CI 1.075-11.966, p=0.038), at one year (98.72% vs 96.12%, aHR=3.001, 95%CI 1.390–6.484, p=0.005) and at five years (95.68% vs 90.86%, aHR=2346, 95%CI 1.289-4.270, p=0.005; Fig 1) after adjusting for demographics and co-morbidities . Patients in the most deprived tercile were more likely to suffer cardiovascular/PE related death in the first (0.43% vs 1.94% mortality, aHR=5.123, 95%CI 1.359-19.310, p=0.016) but not after fifth year (1.12% vs 3.69% mortality, aHR=2.635, 95%CI 0.993-6.990, p=0.052). 40.43% of these deaths were due to PE, 42.55% due to cardiac arrest and 17.02% due to heart failure. Compared with patients in the least deprived cohort, socioeconomically deprived patients were more likely to be hospitalized during the five years post-PE (11.73% vs 20.68% readmission, HR=1.525 95%CI 1.105-2.105 p=0.01) but not at 1 year ( 5.77% vs 8.58% readmission, aHR=1.345 95%CI 0.767-2.355, p=0.300).

Conclusions: Patients with sPE from deprived neighborhoods have worse survival, are more likely to suffer from cardiovascular/PE-related death in the first year and require long-term hospital readmissions . More intense and focused follow-up, and risk factor modification may help mitigate these disparities.