Poorer patients present with more advanced pulmonary hypertension

"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."