Important Differences in Disease Severity, Echocardiography Findings, and Referral Delays in Non-Hispanic Black Patients With Pulmonary Arterial Hypertension.

Abstract

Awareness of health disparities that exist across different self-identified racial and ethnic groups are essential to developing interventions that improve the quality of care of patients with rare diseases such as pulmonary arterial hypertension (PAH). We sought to determine whether there are important differences in clinical characteristics and illness severity at the time of PAH diagnosis among different racial/ethnic groups. 110 patients followed at the University of Illinois Health Pulmonary Hypertension Clinic diagnosed with PAH between 2010 and 2019 were enrolled in our retrospective cohort study. Self-reported race, ethnicity, ZIP code, and standard clinical measures were obtained from the electronic medical record. Comparisons of clinical severity, hemodynamic measurements, social vulnerability, income, and timing of diagnostic testing were made between non-Hispanic Black and non-Black subjects. Our data shows that PAH is more severe at the time of diagnosis in non-Hispanic Black patients compared to non-Black patients, by both clinical and hemodynamic assessments. Tricuspid regurgitant velocity correlated poorly with invasive hemodynamics in non-Hispanic Black patients, yet measures of RV performance were worse than non-Black counterparts. Increased social vulnerability and income inequality was evident between the groups. When compared to non-Black patients, there were significant delays between abnormal echocardiogram findings and completion of diagnostic catheterization. These results implicate concerning health disparities in non-Hispanic Black patients with PAH. More severe disease at time of diagnosis and longer delays from time of symptom onset to PAH diagnosis have both been associated with increased mortality in this population and future work should be aimed at comprehensive strategies to reduce this disparity.