Abstract
Mortality from pulmonary embolism (PE) has declined in the United States over the past two decades, yet significant racia l disparities persist with the age-adjusted rates for blacks about twice those for whites. Incidence studies to date have not been successful in defining reasons for this disparity, primarily because they have not enrolled sufficient numbers of blacks to allow for racial comparisons. This study overcomes that limitation by using New Jersey hospital discharge data as a surrogate measure for PE incidence. It examines whether differences in access to care, in-hospital case fatality, discharge planning or other factors might help explain the observed patterns. Our results revealed an elevation in the incidence of PE among blacks compared with whites, similar to the contrasts in mortality. In-hospital case fatality did not differ notably between blacks and whites, indicating that treatment in-hospital is an unlikely contributing factor. We found differences in hospital discharge planning and insurance status, suggesting that these factors may play a role. Our results point to the need for longitudinal studies on the natural history of the disease to better identify and hopefully modify the risk factors responsible for the persistent disparity in mortality from PE.
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- Anderson F. A., Jr, Wheeler H. B., Goldberg R. J., Hosmer D. W., Patwardhan N. A., Jovanovic B., Forcier A., Dalen J. E. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991 May;151(5):933–938. [PubMed] [Google Scholar]
- Guess H. A., Jacobsen S. J., Girman C. J., Oesterling J. E., Chute C. G., Panser L. A., Lieber M. M. The role of community-based longitudinal studies in evaluating treatment effects. Example: benign prostatic hyperplasia. Med Care. 1995 Apr;33(4 Suppl):AS26–AS35. [PubMed] [Google Scholar]
- Guess H. A., Stephenson W. P., Sacks S. T., Gardner J. S. Beyond pharmacoepidemiology: the larger role of epidemiology in drug development. J Clin Epidemiol. 1988;41(10):995–996. doi: 10.1016/0895-4356(88)90037-6. [DOI] [PubMed] [Google Scholar]
- Kaplan Judith B., Bennett Trude. Use of race and ethnicity in biomedical publication. JAMA. 2003 May 28;289(20):2709–2716. doi: 10.1001/jama.289.20.2709. [DOI] [PubMed] [Google Scholar]
- Lilienfeld D. E. Decreasing mortality from pulmonary embolism in the United States, 1979-1996. Int J Epidemiol. 2000 Jun;29(3):465–469. [PubMed] [Google Scholar]
- Silverstein M. D., Heit J. A., Mohr D. N., Petterson T. M., O'Fallon W. M., Melton L. J., 3rd Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998 Mar 23;158(6):585–593. doi: 10.1001/archinte.158.6.585. [DOI] [PubMed] [Google Scholar]
- Skaf Elias, Stein Paul D., Beemath Afzal, Sanchez Julia, Olson Ronald E. Fatal pulmonary embolism and stroke. Am J Cardiol. 2006 Apr 27;97(12):1776–1777. doi: 10.1016/j.amjcard.2006.01.042. [DOI] [PubMed] [Google Scholar]
- Tanaka Atsushi, Kawarabayashi Takahiko, Fukuda Daiju, Nishibori Yoshiharu, Sakamoto Tsunemori, Nishida Yukio, Shimada Kenei, Yoshikawa Junichi. Circadian variation of plaque rupture in acute myocardial infarction. Am J Cardiol. 2004 Jan 1;93(1):1–5. doi: 10.1016/j.amjcard.2003.09.002. [DOI] [PubMed] [Google Scholar]
- White Richard H., Zhou Hong, Murin Susan, Harvey Danielle. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost. 2005 Feb;93(2):298–305. doi: 10.1160/TH04-08-0506. [DOI] [PubMed] [Google Scholar]
- Worsley D. F., Alavi A. Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study. J Nucl Med. 1995 Dec;36(12):2380–2387. [PubMed] [Google Scholar]