Racial Disparities in the Management of Deep Vein Thrombosis: A Nationwide Hospitalization Study

Background

Deep vein thrombosis (DVT) is a potentially life threatening condition with significant risks if not managed properly. Certain racial and ethnic groups experience higher DVT rates due to genetic, socioeconomic, and lifestyle factors. Comorbid conditions like obesity, hypertension, and diabetes also affect DVT risk. Minority populations face barriers such as lack of insurance, geographic limitations, and fewer healthcare facilities, which contribute to reduced access to preventive care and treatment. These disparities can lead to delays in diagnosis and treatment, with minority patients often receiving less aggressive care and monitoring, resulting in poorer management of anticoagulation therapy. In this study, we analyzed the impact of race on hospitalization outcomes of DVT.

Methods

We used the National Inpatient Sample (2016-2020) database to conduct a retrospective study. International Classification of Diseases-10th revision codes were used to identify DVT hospitalizations. Race was stratified to Whites, Blacks, Hispanics and others. Whites were taken as the reference group. The outcomes studied were type of admission (elective vs emergent), type of disposition (home vs facility or home with home healthcare or death), total length of hospital stay and hospitalization charges. Multivariate regression was used to analyze the impact of race on in hospital outcomes of DVT after adjusting for age, gender, insurance, location, hospital characteristics and Charlson comorbidity index.

Results

We identified 4,118,314 DVT hospitalizations, with 67% of patients being White, 19.31% Black, 8.66% Hispanic, and 5.01% from other racial groups. The average age of patients was 63.88 years, and 48.11% were female. Income distribution varied by racial group: Whites were evenly distributed across income quartiles (Q : Ist - 0 to 25 percentile, 2nd - 26 to 50 percentile, 3rd - 51 to 75 percentile, 4th - 76 to 100 percentile) (23% in the 1st, 26% in the 2nd, 26% in the 3rd, and 23% in the 4th Q); Blacks had higher representation in the 1st Q (52%) and lower in the 4th (11%); Hispanics were most represented in the 1st Q (38%) and least in the 4th (14%); and others had a more balanced distribution (30% in the 1st, 25% in the 2nd, 24% in the 3rd, and 21% in the 4th Q) [p<0.001]. Most patients, regardless of race, were admitted to urban teaching hospitals (72% of Whites, 82% of Blacks, 78% of Hispanics, and 80% of others) [p<0.001]. Whites primarily sought care in the Southern US (36.5%), followed by the Midwest (25%), Northeast (19%), and West (18%). Blacks also predominantly sought care in the Southern US (51%), with fewer in the Midwest (21%), Northeast (18%), and West (9%). Hispanics sought care in the Southern (39%) and Western US (38%) in roughly equal proportions which aligns with the geographical distribution of these patients. Others were most frequently seen in the West (33%), followed by the South (30%) and Northeast (25%) [p<0.001]. Medicare was the primary insurance for most patients [p<0.001]. Multivariate regression analysis revealed that, compared to Whites, Blacks and Hispanics had lower odds of elective admissions [Blacks: OR 0.66, 95% CI (CI) 0.63-0.68, p<0.001; Hispanics: OR 0.86, CI 0.82-0.91, p<0.001], while Others had higher odds of elective admissions [OR 1.06, CI 1.01-1.14, p=0.05]. Blacks had higher odds of mortality compared to Whites [OR 1.13, CI 1.06-1.15, p<0.001], whereas Hispanics had lower odds [OR 0.87, CI 0.81-0.93, p<0.001]. The likelihood of being discharged to a nursing home or home health care was higher for Blacks [OR 1.14, CI 1.05-1.23, p<0.001] and Others [OR 1.48, CI 1.30-1.69, p<0.001]. All racial groups had significantly higher odds of increased total hospitalization days and costs compared to Whites. The length of stay was greater among Blacks [OR 1.22, CI 1.19-1.24, p<0.001], Hispanics [OR 1.16, CI 1.13-1.19, p<0.001], and Others [OR 1.30, CI 1.25-1.34, p<0.001]. Total charges were higher for Blacks [β 8,495, CI 6,002-10,988, p<0.001], Hispanics [β 33,422, CI 29,104-37,741, p<0.001], and Others [β 39,418, CI 33,339-45,497, p<0.001].

Conclusion

Our study indicates that racial disparities in DVT care can affect treatment outcomes and overall health equity. The observed poor outcomes, such as higher rates of non-elective admissions, increased healthcare utilization, and elevated mortality among minority racial groups, must be addressed to alleviate the healthcare burden.