Abstract 4366574: Where You Live Matters: Regional Inequalities in Cor Pulmonale Hospitalizations from 2010-2020

Abstract

Introduction: Cor Pulmonale (CP) is a potentially life-threatening condition characterized by an enlarged right ventricle that could ultimately lead to failure of the right heart. CP-associated hospitalizations have steadily increased across the United States, but little research exists to characterize the present geographic inequalities. Objective: To identify and assess disparities in CP-associated hospitalizations across the United States from 2010-2020 by region. Methods: We utilized CP hospitalization data from the National Inpatient Sample (NIS) from 2010 to 2020. We included adult patients (>18 years) hospitalized with an ICD-9 diagnosis code of 416 and an ICD-10 diagnosis code of I27.9 for Pulmonary Heart Disease. Sampling weights were applied to generate national estimates. The US and region-specific population data was obtained from the National Census Bureau (NCB). Linear trend analysis of CP-associated hospitalizations stratified into four regions assessed regional annual increases. Disparity Ratio and Chi-Square analysis assessed annual differences in regional disparities. Results: CP diagnoses among the weighted population increased by 28% (P<0.0001, n=11474252) over the past decade, with the Northeast, Midwest, South, and West following trends of (36%, P<0.0001), (21%, P<0.0001), (26%, P<0.0001), (32%, P<0.001), respectively. The disparity ratios for Northeastern, Midwest, South, and Western regions averaged over the decade were 1.07, 1.2, 0.98, and 0.80, respectively. For the Northeast, observed hospitalizations were slightly elevated for all years except 2010. Midwestern region hospitalization values were consistently higher than expected for all years. Southern region hospitalizations generally trended with expected values. Western region hospitalizations were consistently lower than expected values for all years. The statistical analysis of each region’s disparity ratio using the Chi-Square test found every year statistically significant (P<0.0001). Conclusions: While total CP-associated hospitalizations increased over the decade, the Midwest consistently had more hospitalizations than would be predicted, indicating the region’s disproportionately high CP-associated hospitalization rate. The Western region consistently had fewer hospitalizations than expected. These results suggest a need for targeted investigations into environmental, behavioral, healthcare access, and diagnostic practices specific to regions for Cor Pulmonale.