Poverty and Social Deprivation in Patients With Pulmonary Arterial Hypertension—A PHAR Analysis

Roberto J. Bernardo, Di Lu, Haley Hedlin, Daniel Grinnan, Roberto F. Machado, Lana Melendres-Groves, Jean M. Elwing, Sandeep Sahay, Steven M. Kawut, Jeffrey C. Robinson, Vinicio A. de Jesus Perez, Roham T. Zamanian, PHAR Investigators

https://doi.org/10.1002/pul2.70373 

Abstract

Poverty and social deprivation have been associated with impaired clinical outcomes and survival in several chronic diseases. The association between poverty and clinical outcomes in patients with pulmonary arterial hypertension (PAH) remains unclear. We aim to determine the association between federal poverty levels with healthcare use and clinical outcomes in PAH. Using the Pulmonary Hypertension Association Registry, we performed a prospective cohort analysis comparing clinical and socioeconomic characteristics in PAH patients above or below federal poverty levels. We studied the association between federal poverty levels and healthcare use patterns and transplant-free survival using a Cox proportional hazards model. A total of 1396 participants were included, 411 (29.4%) under poverty levels. The in-poverty group was mostly non-White and Hispanic, had mainly public health insurance/Medicaid (37.0% vs. 5.5%; absolute standardized difference [ASD] 0.84), lower educational attainment (17.2% vs. 45.6% college graduate or higher; ASD 0.64), lower rates of employment/retirement (27.3% vs. 71.1%; ASD 0.98), higher frequency of methamphetamine exposure (31.5% vs. 9.8%; ASD 0.57), and lower frequency of idiopathic/heritable PAH (36.0% vs. 47.8%; ASD 0.65), than the not in-poverty group. While there were no differences in severity of disease or treatment, the in-poverty group had higher incidence rate ratios of emergency room visits and hospitalizations (IRR 2.19, 95% CI 1.99–2.40, and 1.51, 95% CI 1.36–1.68, respectively). There were no differences in transplant-free survival (p = 0.10). Poverty was not associated with worse survival in patients with PAH but was associated with higher rates of emergency room visits and hospitalizations, suggesting suboptimal disease control despite similar disease severity.

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