Health insurance and racial disparities in pulmonary hypertension outcomes.

Abstract

OBJECTIVES: Pulmonary hypertension portends a poorer prognosis for blacks versus white populations, but the underlying reasons are poorly understood. We investigated associations of disease characteristics, insurance status, and race with clinical outcomes. STUDY DESIGN: Retrospective cohort study of patients presenting for initial pulmonary hypertension evaluation at 2 academic referral centers. METHODS: We recorded insurance status (Medicare, Medicaid, private, self-pay), echocardiographic, and hemodynamics data from 261 patients (79% whites, 17% blacks) with a new diagnosis of pulmonary hypertension. Subjects were followed for 2.3 years for survival. Adjustment for covariates was performed with Cox proportional hazards modeling. RESULTS: Compared with white patients, blacks were younger (50 ± 15 vs 53 ± 12 years; P = .04), with females representing a majority of patients in both groups (80% vs 66%; P = .08) and similar functional class distribution (class 2/3/4: 30%/52%/16% blacks vs 33%/48%/14% whites; P = .69). Blacks diagnosed with incident pulmonary hypertension were more frequently covered by Medicaid (12.5% vs 0.7%) and had less private insurance (50% vs 61%; P = .007) than whites. At presentation, blacks had more right ventricular dysfunction (P = .04), but similar mean pulmonary arterial pressure (46 vs 45 mm Hg, respectively; P = .66). After adjusting for age and functional class, blacks had greater mortality risk (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.18-3.44), which did not differ by race after additional adjustment for insurance status (HR, 1.74; 95% CI, 0.84-3.32; P =.13). CONCLUSIONS: In a large cohort of patients with incident pulmonary hypertension, black patients had poorer right-side heart function and survival rates than white patients. However, adjustment for insurance status in our cohort removed differences in survival by race.

Department

Description

Provenance

Subjects

Citation

Scholars@Duke

Parikh

Kishan S Parikh

Adjunct Associate in the Department of Medicine

Duke University Medical Center
Duke Clinical Research Institute

Bashore

Thomas Michael Bashore

Professor Emeritus of Medicine

The major areas of research involve mostly hemodynamic and imaging research:
1. Valvular heart disease.
2. Adult congenital heart disease.
3. Pulmonary Hypertension.
4. Complex cardiovascular problems.

The Valvular Disease Program and Adult Congenital Program are nationally recognized, and many trainees have gone on to academic careers at a number of universities. Dr. Bashore is now or recently has been on the Editorial Boards of Circulation, the American Journal of Cardiology, Cardiac Catheterization and Intervention, the Journal of Heart Valve Disease, the American Heart Journal, Cardiology Today, the Journal of Invasive Cardiology and the Journal of the American College of Cardiology. He was formerly director of the Diagnostic Cardiac Catheterization Laboratories for 10 years, and then the Director of the Cardiology Fellowship Training Program for 12 years. He is currently the Clinical Chief of the Division of Cardiology. He is a member and/or chairman of numerous committees of the American College of Cardiology and author of over 250 manuscripts, over 70 book chapters and reviews and 3 books. Dr. J. Kevin Harrison, Dr. Andrew Wang, Dr. Tom Gehrig, Dr. Todd Kiefer, Dr. Michael Sketch and Dr. Cary Ward complement the research team along with a variety of research personnel. Currently research is focused on the percutaneous treatment of structural heart disease and adult congenital heart disease.

Krasuski

Richard Andrew Krasuski

Professor of Medicine

Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University Medical Center, the Director of Hemodynamic Research, and the Medical Director of the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension and congenital heart disease. His research focus is in epidemiologic and clinical studies involving patients with pulmonary hypertension and patients with congenital heart disease. He is involved in multiple multicenter studies through the Alliance for Adult Research in Congenital Cardiology (AARCC). He has also helped to develop multiple research databases in these patient populations. He is Co-PI in the upcoming EPIPHANY Study examining the impact of medical and transcatheter interventions on RV-PA coupling in patients with chronic thromboembolic pulmonary hypertension. Over his career he has mentored over 80 students, residents and fellows and has published over 300 peer reviewed publications, book chapters and meeting abstracts. He is also the Chief Editor of Advances in Pulmonary Hypertension and on the editorial boards of several leading medical journals.


Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.