Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry
Compared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to dete...
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Wiley
2021-07-01
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| Series: | Pulmonary Circulation |
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| Online Access: | https://doi.org/10.1177/20458940211020913 |
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| author | Hilary M. DuBrock Charles D. Burger Sonja D. Bartolome Jeremy P. Feldman D. Dunbar Ivy Erika B. Rosenzweig Jeffrey S. Sager Kenneth W. Presberg Stephen C. Mathai Matthew R. Lammi James R. Klinger Michael Eggert Teresa De Marco Jean M. Elwing David Badesch Todd M. Bull Linda M. Cadaret Gautam Ramani Thenappan Thenappan H. James Ford Nadine Al‐Naamani Marc A. Simon Sula Mazimba James R. Runo Murali Chakinala Evelyn M. Horn John J. Ryan Robert P. Frantz Michael J. Krowka PHAR Investigators |
| author_facet | Hilary M. DuBrock Charles D. Burger Sonja D. Bartolome Jeremy P. Feldman D. Dunbar Ivy Erika B. Rosenzweig Jeffrey S. Sager Kenneth W. Presberg Stephen C. Mathai Matthew R. Lammi James R. Klinger Michael Eggert Teresa De Marco Jean M. Elwing David Badesch Todd M. Bull Linda M. Cadaret Gautam Ramani Thenappan Thenappan H. James Ford Nadine Al‐Naamani Marc A. Simon Sula Mazimba James R. Runo Murali Chakinala Evelyn M. Horn John J. Ryan Robert P. Frantz Michael J. Krowka PHAR Investigators |
| author_sort | Hilary M. DuBrock |
| collection | DOAJ |
| description | Compared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to determine whether socioeconomic status and/or POPH diagnosis were associated with treatment and health‐care utilization. We performed a cross‐sectional study of adults enrolled in the Pulmonary Hypertension Association Registry. Patients with IPAH (n = 344) and POPH (n = 57) were compared. Compared with IPAH, patients with POPH were less likely to be college graduates (19.6% vs. 34.9%, p = 0.02) and more likely to be unemployed (54.7% vs. 30.5%, p < 0.001) and have an annual household income below poverty level (45.7% vs. 19.0%, p < 0.001). Patients with POPH had similar functional class, quality of life, 6‐min walk distance, and mean pulmonary arterial pressure with a higher cardiac index. Compared with IPAH, patients with POPH were less likely to receive combination therapy (46.4% vs. 62.2%, p = 0.03) and endothelin receptor antagonists (28.6% vs. 55.1%, p < 0.001) at enrollment with similar treatment at follow‐up. Patients with POPH had more emergency department visits (1.7 ± 2.1 vs. 0.9 ± 1.2, p = 0.009) and hospitalizations in the six months preceding enrollment (1.5 ± 2.1 vs. 0.8 ± 1.1, p = 0.02). Both POPH diagnosis and lower education level were independently associated with a higher number of emergency department visits. Compared to IPAH, patients with POPH have lower socioeconomic status, are less likely to receive initial combination therapy and endothelin receptor antagonists but have similar treatment at follow‐up, and have increased health‐care utilization. |
| format | Article |
| id | doaj-art-0eb2fcb1424a48d382c3a48edad8720f |
| institution | OA Journals |
| issn | 2045-8940 |
| language | English |
| publishDate | 2021-07-01 |
| publisher | Wiley |
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| series | Pulmonary Circulation |
| spelling | doaj-art-0eb2fcb1424a48d382c3a48edad8720f2025-08-20T02:27:31ZengWileyPulmonary Circulation2045-89402021-07-0111311010.1177/20458940211020913Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association RegistryHilary M. DuBrock0Charles D. Burger1Sonja D. Bartolome2Jeremy P. Feldman3D. Dunbar Ivy4Erika B. Rosenzweig5Jeffrey S. Sager6Kenneth W. Presberg7Stephen C. Mathai8Matthew R. Lammi9James R. Klinger10Michael Eggert11Teresa De Marco12Jean M. Elwing13David Badesch14Todd M. Bull15Linda M. Cadaret16Gautam Ramani17Thenappan Thenappan18H. James Ford19Nadine Al‐Naamani20Marc A. Simon21Sula Mazimba22James R. Runo23Murali Chakinala24Evelyn M. Horn25John J. Ryan26Robert P. Frantz27Michael J. Krowka28PHAR InvestigatorsDivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMayo ClinicRochesterMNUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMayo ClinicJacksonvilleFLUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineArizona Pulmonary Specialists, LtdScottsdaleAZUSADivision of CardiologyDepartment of PediatricsChildren’s Hospital ColoradoAuroraCOUSADivision of CardiologyDepartment of PediatricsColumbia University Medical CenterNew YorkNYUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineCottage Pulmonary Hypertension CenterSanta BarbaraCAUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMedical College of WisconsinMilwaukeeWIUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineJohns Hopkins UniversityBaltimoreMDUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineComprehensive Pulmonary Hypertension CenterLouisiana State University Health Sciences CenterNew OrleansLAUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineBrown UniversityProvidenceRIUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineSentara Cardiovascular Research InstituteNorfolkVAUSADivision of CardiologyDepartment of Internal MedicineUniversity of California San FranciscoSan FranciscoCAUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of CincinnatiCincinnatiOHUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of ColoradoDenverCOUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of ColoradoDenverCOUSADivision of CardiologyDepartment of Internal MedicineRoy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIAUSADivision of CardiologyDepartment of Internal MedicineUniversity of Maryland School of MedicineBaltimoreMDUSADivision of CardiologyDepartment of Internal MedicineUniversity of MinnesotaMinneapolisMNUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of PennsylvaniaPhiladelphiaPAUSADivision of CardiologyDepartment of Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghPAUSADivision of CardiologyDepartment of Internal MedicineUniversity of Virginia Health SystemCharlottesvilleVAUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of Wisconsin–MadisonMadisonWIUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineWashington University at Barnes‐JewishSt. LouisMOUSADivision of CardiologyDepartment of Internal MedicineWeill Cornell Medical SchoolNew YorkNYUSADivision of CardiologyDepartment of Internal MedicineUniversity of UtahSalt Lake CityUTUSADepartment of Cardiovascular DiseasesMayo ClinicRochesterMNUSADivision of Pulmonary and Critical Care MedicineDepartment of Internal MedicineMayo ClinicRochesterMNUSACompared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to determine whether socioeconomic status and/or POPH diagnosis were associated with treatment and health‐care utilization. We performed a cross‐sectional study of adults enrolled in the Pulmonary Hypertension Association Registry. Patients with IPAH (n = 344) and POPH (n = 57) were compared. Compared with IPAH, patients with POPH were less likely to be college graduates (19.6% vs. 34.9%, p = 0.02) and more likely to be unemployed (54.7% vs. 30.5%, p < 0.001) and have an annual household income below poverty level (45.7% vs. 19.0%, p < 0.001). Patients with POPH had similar functional class, quality of life, 6‐min walk distance, and mean pulmonary arterial pressure with a higher cardiac index. Compared with IPAH, patients with POPH were less likely to receive combination therapy (46.4% vs. 62.2%, p = 0.03) and endothelin receptor antagonists (28.6% vs. 55.1%, p < 0.001) at enrollment with similar treatment at follow‐up. Patients with POPH had more emergency department visits (1.7 ± 2.1 vs. 0.9 ± 1.2, p = 0.009) and hospitalizations in the six months preceding enrollment (1.5 ± 2.1 vs. 0.8 ± 1.1, p = 0.02). Both POPH diagnosis and lower education level were independently associated with a higher number of emergency department visits. Compared to IPAH, patients with POPH have lower socioeconomic status, are less likely to receive initial combination therapy and endothelin receptor antagonists but have similar treatment at follow‐up, and have increased health‐care utilization.https://doi.org/10.1177/20458940211020913pulmonary hypertensionsocioeconomic statushealth‐care utilization |
| spellingShingle | Hilary M. DuBrock Charles D. Burger Sonja D. Bartolome Jeremy P. Feldman D. Dunbar Ivy Erika B. Rosenzweig Jeffrey S. Sager Kenneth W. Presberg Stephen C. Mathai Matthew R. Lammi James R. Klinger Michael Eggert Teresa De Marco Jean M. Elwing David Badesch Todd M. Bull Linda M. Cadaret Gautam Ramani Thenappan Thenappan H. James Ford Nadine Al‐Naamani Marc A. Simon Sula Mazimba James R. Runo Murali Chakinala Evelyn M. Horn John J. Ryan Robert P. Frantz Michael J. Krowka PHAR Investigators Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry Pulmonary Circulation pulmonary hypertension socioeconomic status health‐care utilization |
| title | Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry |
| title_full | Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry |
| title_fullStr | Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry |
| title_full_unstemmed | Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry |
| title_short | Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry |
| title_sort | health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension an analysis of the pulmonary hypertension association registry |
| topic | pulmonary hypertension socioeconomic status health‐care utilization |
| url | https://doi.org/10.1177/20458940211020913 |
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