ATS 2014, SAN DIEGO ─ Pulmonary hypertension patients from lower socioeconomic groups present for initial evaluation at a more advanced disease state than those from higher income groups, according to a new study presented at the 2014 American Thoracic Society International Conference.
"Lower socioeconomic status is associated with reduced access to health care and negative effects on health status, but data on its effects on the care of patients with pulmonary hypertension is scarce," said researcher Jose Cardenas-Garcia, MD, a Pulmonary & Critical Care Fellow at Hofstra North Shore – Long Island Jewish School of Medicine. "In accordance with the pattern seen with many other diseases, we found that patients with lower incomes were more likely to present with more advanced disease than those with higher incomes."
A total of 243 patients were enrolled in the study. Socioeconomic status was measured by zip code-based median annual household income, and New York Heart Association Functional Class (NYHA-FC) was assessed at the patients' initial evaluation. Patients were divided by income into Group A (median income 30,000-70,000 dollars per year) and Group B (median income greater than 70,000 dollars per year).
Functional class at presentation increased, indicating greater disease severity, as median income decreased. At initial presentation, patients in Group A were NYHA-FC I + II (n=23, 25.6%), NYHA-FC III (n=53, 58.9%), and NYHA-FC IV (n=14, 15.6%), while those in Group B were NYHA-FC I+II (n=62, 40.5%), NYHA-FC III (n=77, 50.3%) and NYHA-FC IV (n=14, 9.2%). The relationship between income group and NYHA Functional Class at initial evaluation was significant, (p<0.04, chi-square test).
Study limitations included the small study sample, which was from one pulmonary hypertension clinic in greater New York City. To address these issues, Dr. Cardenas-Garcia's group is currently conducting a multicenter study in order to verify these initial findings.
"Our study indicates that patients with pulmonary hypertension with lower incomes have more advanced disease at initial presentation, which may result in poorer outcomes," said Dr. Cardenas-Garcia. "These results add to a large body of evidence showing that socioeconomic status affects access to health care and the health of individuals."
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Relationship Between Socio-economic Status And Disease Severity At Time Of First Evaluation In Patients With Pulmonary Hypertension
Type: Scientific Abstract
Category: 18.10 - Pulmonary Hypertension: Clinical – Treatment and Outcomes (PC)
Authors: J. Cardenas-Garcia1, A. Talwar2, S. Sahni1, N. Kohn3, A. Talwar1; 1North Shore - LIJ Health System - New Hyde Park, NY/US, 2Herricks High School - New Hyde Park, NY/US, 3Feinstein Institute of Medical Research - Manhasset, NY/US
Purpose: Low socio-economic status [SES] is has been linked to disproportionate access to health care in many diseases. There appears to be a paucity of similar data in the population of patients with pulmonary hypertension [PHTN].
Objective: To determine the association of socio-economic status as measured by zip code based median annual household income with New York Heart Association Functional Class (NYHA-FC) at time of first evaluation amongst patients with pulmonary hypertension (PHTN).
Methods: All PHTN patients (WHO Groups I – V) with a mean pulmonary artery pressure > 25 mmHg (confirmed via right heart catheterization) at our center from 1993 to September 2013 were considered for the study. Demographics, NYHA-FC at initial evaluation and zip codes were obtained from retrospective chart review. There were 243 patients (Male n=71 (29.2%), F=172 (70.8%)). The 2010 US Census was used to obtain zip code based annual median income of the patients. This methodology has been validated as a marker of SES. The income groups were categorized as Group A (n=90; Age 58.9±16.0 yrs.) with median income of 30,000 to 70,000 dollars/year and Group B (n=153; Age 61.7±14.0 yrs.) with a median income greater than 70,000/year. Data was analyzed in SAS and p<.05 was considered significant.
Results: As median income decreased, the functional class at presentation increased, signifying higher disease severity. [Spearman correlation, r= -0.146; p< .0226)]. When income was grouped, PHTN patients from Income Group A at time of initial evaluation were NYHA-FC I + II (n=23, 25.6%), NYHA-FC III (n=53, 58.9%), NYHA-FC IV (n=14, 15.6%). Income Group B patients at time of initial presentation were NYHA-FC I+II (n=62, 40.5%), NYHA-FC III (n=77, 50.3%) and for NYHA-FC IV (n=14, 9.2%). This association between median income groups and NYHA Functional Class at initial evaluation was significant, (p<0.04, chi-square test).
Conclusion: Our results indicate the possible disparity of healthcare accessibility issues between a cohort of patients with PHTN belonging to two different socioeconomic groups. Particularly the lower SES income group (Group A) was associated with more advanced PHTN (as measured by NYHA-FC) at the time of initial evaluation.
Clinical Implications: Our study suggests that patients with low SES may be referred to PHTN centers for initial evaluation at an advanced disease state. Further studies need to be conducted to confirm the association of lower SES and severity of PHTN as measured by NYHA-FC.
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