Social Disparities in Pulmonary Embolism and Deep Vein Thrombosis During COVID-19 Pandemic from a Nationwide Inpatient Sample (2020)

Studies have shown that Coronavirus Disease 2019 (COVID-19) is associated with a hypercoagulable state. Studies have yet to examine the interconnectedness between COVID-19, hypercoagulability, and socioeconomics. The aim of this work is to investigate socioeconomic factors that may be associated with pulmonary embolism (PE), Deep Vein Thrombosis (DVT), and COVID-19 in the United States (U.S.).

Methods:

We performed a 1-year (2020) analysis of the National Inpatient Sample database. We identified all adult patients diagnosed with COVID-19, PE, and DVT. Patients diagnosed with both PE and DVT were excluded. We calculated the correlation and odds ratio (OR) between COVID-19 and 1) PE, and 2) DVT. We executed a univariate analysis followed by a multivariate analysis to examine the effect of different factors on PE and DVT during the COVID-19 pandemic.

Results: 322,319 patients were identified with COVID-19, while 78,101 and 67,826 patients were identified with PE and DVT, respectively. PE (r=0.95) and DVT (r=0.86), as well as, inpatient mortality associated with both conditions (r=0.81 and r=0.80, respectively) are significantly correlated to COVID-19 (Figure 1). The OR between COVID-19 and PE was 2.04 (CI95:1.99-2.09) and COVID-19 and DVT was 1.44 (CI95:1.40-1.48). Using multivariate analysis, COVID-19 was associated with a higher incidence of PE (coefficient 2.05, CI95:2.01-2.10) and DVT (coefficient 1.42, CI95:1.38-1.46). Other factors that were significantly associated (p< 0.001) with  PE and  DVT along with their coefficients and 95% confidence intervals include blacks, 1.23 (1.21-1.25), 1.14 (1.12-1.17); Asians/Pacific Islanders, 0.52 (0.49-0.55), 0.53 (0.50-0.56); female sex, 0.79 (0.77-0.79), 0.74 (0.73-0.75); top quartile income, 1.08 (1.06-1.11), 1.16 (1.13-1.18); west region, 1.10 (1.07-1.13), 1.04 (1.01-1.07); urban teaching facilities, 1.09 (1.06-1.12), 1.63 (1.57-1.68); large bed size hospitals, 1.08 (1.06-1.10), 1.29 (1.27-1.32); homelessness, 0.62 (0.57-0.67), 0.61 (0.56-0.66); insufficient insurance, 1.88 (1.51-2.33), 2.19 (1.77-2.71); diabetes mellitus, 0.77 (0.75-0.78), 0.90 (0.89-0.92); hypertension, 1.24 (1.22-1.26), 1.32 (1.30-1.35); and obesity, 1.41 (1.39-1.44), 1.25 (1.23-1.27) (Table 1).

Conclusions: In a nationwide inpatient sample of the U.S., PE & COVID-19 and DVT & COVID-19 were significantly correlated. Blacks, males, top quartile income earners, west region, urban teaching facilities, large bed size hospitals, insufficient insurance, hypertension, and obesity were associated with a higher likelihood of PE and DVT. Asians/Pacific Islanders, females, homelessness, and diabetes mellitus were associated with a lower likelihood of PE and DVT.