Disparities in access and timing of interventional therapies for pulmonary embolism across the United States

Background Interventional therapies (IT) are an emerging treatment modality for pulmonary embolism, however the degree of racial, sex-based and sociodemographic disparities in access and timing is unknown. Methods A retrospective cohort study utilizing the Nationwide Inpatient Sample from 2016-2020 included adult patients with PE. The use of IT (mechanical thrombectomy and catheter-directed thrombolysis) was identified via ICD10 code. Early IT was defined as procedure within the first 2 days after admission. Results A total of 27,805,273 records from the 2016-2020 NIS samples were examined. There were 387,514 (1.4%) patients with PE, with 14,249 (3.6%) of them undergoing IT procedures (11,115 catheter-directed thrombolysis, 2,314 thrombectomy, 780 both procedures). After multivariate adjustment, factors associated with less use of IT included: Black race (OR 0.90, 0.86-0.94, p<0.01), Hispanic race (OR 0.73, 0.68-0.79, p<0.01), female sex (OR 0.88, 0.85-0.91, p<0.01), treatment in a rural hospital (OR 0.49, 0.44-0.54, p<0.01), and lack of private insurance (Medicare OR 0.77, 0.73-0.80 p<0.01, Medicaid OR 0.65, 0.61-0.69 p<0.01, No coverage OR 0.87, 0.82-0.93, p<0.01). Of the patients who received IT, 11,315 (79%) of these were conducted within 2 days of admission, and 2,934 (21%) were delayed. Factors associated with delayed procedures include Black race (OR 1.12, 1.01-1.26, p=0.04), Hispanic race (OR 1.52, 1.28-1.80, p<0.01), weekend admission (OR 1.37, 1.25-1.51, p<0.01), Medicare coverage (OR 1.24, 1.10-1.40, p<0.01), and Medicaid coverage (OR 1.29, 1.12-1.49, p<0.01). Conclusions Significant racial, sex-based and geographic barriers exist in overall access to IT for PE in the United States.