期刊
ANNALS OF THE AMERICAN THORACIC SOCIETY
卷 20, 期 12, 页码 1718-1725出版社
AMER THORACIC SOC
DOI: 10.1513/AnnalsATS.202305-424OC
关键词
epidemiology; regional variation; pulmonary vascular disease; social determinants of health
This study found significant regional variation in the characteristics and outcomes of pulmonary arterial hypertension (PAH) patients in the United States. The study analyzed participants in the Pulmonary Hypertension Association Registry (PHAR) and identified differences in age, race, marital status, employment, insurance, smoking, alcohol use, etiology, and treatment characteristics among different census regions. The study also found lower mortality in PHAR participants in the West region. This study highlights the need for further research and improvement in providing equitable care for PAH patients in the United States.
Rationale: Pulmonary arterial hypertension (PAH) is a heterogeneous disease within a complex diagnostic and treatment environment. Other complex heart and lung diseases have substantial regional variation in characteristics and outcomes; however, this has not been previously described in PAH. Objectives: To identify baseline differences between U.S. census regions in the characteristics and outcomes for participants in the Pulmonary Hypertension Association Registry (PHAR). Methods: Adults with PAH were divided into regional groups (Northeast, South, Midwest, andWest), and baseline differences between census regions were presented. Kaplan-Meier survival analyses and Cox proportional hazards were used to estimate the association between region and mortality in unadjusted and adjusted models. Results: Substantial differences by census regions were seen in age, race, ethnicity, marital status, employment, insurance payor breakdown, active smoking, and current alcohol use. Differences were also seen in PAH etiology and baseline 6-minute walk distance test results. Treatment characteristics varied by census region, and mortality appeared to be lower in PHAR participants in the West (hazard ratio, 0.60; 95% confidence interval, 0.43-0.83, P = 0.005). This difference was not readily explained by differences in demographic characteristics, PAH etiology, baseline severity, baseline medication regimen, or disease prevalence. Conclusions: The present study suggests significant regional variation among participants at accredited pulmonary vascular disease centers in multiple baseline characteristics and mortality. This variation may have implications for clinical research planning and represent an important focus for further study to better understand whether there are remediable care aspects that can be addressed in the pursuit of providing equitable care in the United States.
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