Variations in Management and Outcomes of Pulmonary Embolism in Uninsured Compared With Privately Insured Individuals

Despite previously noted healthcare disparities, there are limited data on the management and outcomes of uninsured patients presenting with pulmonary embolism (PE). All adult (>18 years) nonelective admissions with a primary diagnosis of PE with either private or uninsured (self-pay or no charge) primary payor were identified using the National Inpatient Sample (2016-2022). We excluded admissions with Medicare and Medicaid payor status. The primary outcome was in-hospital mortality. Secondary outcomes included utilization rates of different interventions, hospital length of stay, hospitalization costs, and discharge disposition. During 01/01/2016 to 12/31/2022, 416,599 admissions were identified as uninsured (54,444) and privately insured (362,155). Compared to those privately insured, the uninsured cohort was on average younger, more frequently male, from a minority race/ethnicity, belonging to lower socioeconomic status, and residing in the southern United States (all p < 0.001). The rates of acute organ failure were largely comparable between the 2 groups. Use of catheter-directed therapies (3.7% vs 4.5%, p = 0.002) and mechanical thrombectomy (3.0% vs 3.5%, p = 0.005) was lower in the uninsured insurance subgroup, but systemic thrombolysis and surgical thrombectomy were similar. The uninsured cohort had comparable rates of in-hospital mortality (2.9% vs 2.3%, adjusted odds ratio 1.19; 95% confined interval 0.98-1.46; p = 0.07). The uninsured cohort also had longer hospitalization duration, higher hospitalization costs, and higher rates of leaving against medical advice (all p < 0.05). In conclusion, using over 7 years of retrospective data, we noted that despite comparable in-hospital mortality, there were significant socioeconomic differences between uninsured and privately insured admissions with PE.