| Autor: |
Fling C; Department of Medicine., De Marco T; Division of Cardiology, University of California, San Francisco, San Francisco, California., Kime NA; Department of Biostatistics., Lammi MR; Division of Pulmonary and Critical Care Medicine, Louisiana State University, New Orleans, Louisiana., Oppegard LJ; Division of Pulmonary and Critical Care Medicine, Oregon Health Sciences University, Portland, Oregon., Ryan JJ; Division of Cardiology, University of Utah, Salt Lake City, Utah., Ventetuolo CE; Department of Medicine and.; Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island., White RJ; Division of Pulmonary and Critical Care Medicine and.; the Mary M. Parkes Center, University of Rochester, Rochester, New York; and., Zamanian RT; Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California., Leary PJ; Department of Epidemiology, and.; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington. |
| Abstrakt: |
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, and West), 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. |
