J Vasc Surg Venous Lymphat Disord. 2023 Sep 12:S2213-333X(23)00335-9. doi: 10.1016/j.jvsv.2023.08.022. Online ahead of print.
OBJECTIVE: To determine whether racial and ethnic disparities existed in inferior vena cava filter placement rates among Black and Latino patients for the treatment of acute proximal lower extremity deep vein thrombosis in the United States.
METHODS: We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis acute proximal lower extremity deep vein thrombosis from January 2016 to December 2019, including self-reported patient race and ethnicity. Filter placement rates were identified using International Classification of Diseases-10 codes. Weighted multivariable logistic regression was used to compare inferior vena cava filter use by race and ethnicity. The regression model was adjusted for patient demographics (sex, primary payer, quartile classification of household income), hospital information (region, location, teaching status, bed size), weekend admission, and clinical characteristics (modified Charlson Comorbidity Index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, as well as contraindications to anticoagulation including other major bleeding).
RESULTS: Of 134,499 acute proximal lower extremity deep vein thrombosis patients, 18,909 (14.1%) received an inferior vena cava filter. Of the patients who received these filter devices, 12,733 were White (67.3%), 3,563 were Black (18.8%), and 1,679 were Latino (8.9%). Filter placements decreased in all patient groups between 2016 and 2019. After adjusting for the United States population distribution, filter placement rates were 11-12/100,000 in Black patients, 7-8/100,000 in White patients, and 4-5/100,000 in Latino patients. There was a statistically significant difference in filter placement rates between patient groups: Black patients compared to White patients (p<0.05), Black patients compared to Latino patients (p<0.05), and Latino patients compared to White patients (p<0.05).
CONCLUSION: This nationwide study showed that Black patients had higher inferior vena cava filter placement rates, when compared to White and Latino patients. Given the known long-term complications and uncertain benefits of these filters, coupled with the 2010 United States Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias may be perpetuating this disparity.