Socioeconomic Disadvantage Is Associated with Health Care Disparities in Mortality, Readmission and Long-Term Anticoagulation in Young Patients Following Submassive (Intermediate-Risk) Pulmonary Embolism

Background Submassive pulmonary embolism (sPE) can result in increased morbidity and mortality but the impact of social determinants of health using the Area Deprivation Index (ADI) on outcomes has not been explored. Methods Patients admitted with sPE (2013-2019) at one health care network were divided into terciles by ADI. To capture a workforce cohort, patients older than 60 or with a diagnosis of cancer were excluded. Outcomes included overall and cardiovascular and pulmonary embolism (PE) specific mortality. Groups were compared using Kaplan–Meier curves, and multivariable Cox-proportional models. Time-to-readmission was also compared. Results A total of 2,013 patients met selection criteria. More deprived patients were more likely to be younger, female, of Black race, and smokers ( P < 0.001) with a greater incidence of comorbidities ( P < 0.05). Compared with residence in less deprived areas, residence in more deprived neighborhoods was associated with worse survival at 1 year (98.8% vs. 96.1%, adjusted hazard ratio [aHR] = 3.23, [1.69–6.20], P < 0.001) and at 5 years (95.8% vs. 90.9%, aHR = 2.46, [1.49–4.06], P < 0.001). Residence in the most deprived neighborhoods was associated with higher cardiovascular and PE specific mortality in the first (0.4% vs. 2.0% mortality, aHR = 4.87, [1.28–18.55], P = 0.02). Residence in the most deprived neighborhoods was associated with more readmissions as well (6.4% vs. 11.1%, P = 0.005, aHR = 1.39 95% confidence interval [CI] = 1.12–1.71, P = 0.002). Conclusion Among patients with sPE, residence in deprived neighborhoods was associated with increased overall, cardiovascular and PE specific mortality as well as long-term hospital readmissions. Socioeconomic deprivation was also associated with lower anticoagulation use and compliance after discharge. Focused follow-up may help mitigate these disparities.