COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample
Abstract
:1. Introduction
2. Materials and Methods
- Patient: age, race (white, black, Hispanic, Native American, Asian, other), sex, insurance status (Medicare, Medicaid, private insurance, self-payment, no charge), median income based on patient’s zip code, and disposition.
- Hospital: location, teaching status, bed size, and region.
- Illness severity: length of stay (L.O.S.), mortality, hospitalization cost, comorbidities, mechanical ventilation, circulatory support, and vasopressor use.
- Intubation and mechanical ventilation;
- Vasopressor use;
- Length of stay, the financial burden on healthcare, and resource utilization.
Statistical Analysis
3. Results
3.1. Demographics and Baseline Comorbidities
3.2. In-Hospital Mortality
3.3. In-Hospital Complications
3.4. In-Hospital Quality Measures and Disposition
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | COVID-19 without Pulmonary Embolism n (%) | COVID-19 with Pulmonary Embolism n (%) | p Value |
---|---|---|---|
n = 1,659,040 | 1,612,600 (97.2%) | 46,440 (2.8%) | |
SEX (Female) | 789,368 (48.95%) | 19,064 (41.05%) | <0.001 |
Mean age years (SD) | <0.001 | ||
Male | 63.4 (16.3) | 62.92 (14.9) | |
Female | 63.0 (18.9) | 65.68 (15.9) | |
AGE GROUPS (%) | <0.001 | ||
≥18–29 | 80,953 (5.02%) | 1059 (2.28%) | |
30–49 | 271,562 (16.84%) | 7156 (15.41%) | |
50–69 | 597,791 (37.07%) | 19,890 (42.83%) | |
≥70 | 662,295 (41.07%) | 18,335 (39.48%) | |
RACE (%) | <0.001 | ||
Caucasians | 819,846 (50.84%) | 24,757 (53.31%) | |
African American | 305,265 (18.93%) | 10,788 (23.23%) | |
Hispanics | 348,644 (21.62%) | 7625 (16.42%) | |
Asian or Pacific Islander | 52,732 (3.27%) | 1073 (2.31%) | |
Native American | 16,610 (1.03%) | 418 (0.9%) | |
Others | 69,342 (4.3%) | 1765 (3.8%) | |
MEDIAN HOUSEHOLD INCOME (%) | <0.001 | ||
<49,999$ | 550,542 (34.14%) | 15,423 (33.21%) | |
50,000–64,999$ | 438,143 (27.17%) | 13,073 (28.15%) | |
65,000–85,999$ | 357,352 (22.16%) | 10,286 (22.15%) | |
>86,000$ | 266,563 (16.53%) | 7658 (16.49%) | |
INSURANCE STATUS (%) | 0.003 | ||
Medicare | 859,354 (53.29%) | 23,847 (51.35%) | |
Medicaid | 245,599 (15.23%) | 5930 (12.77%) | |
Private | 443,787 (27.52%) | 14,875 (32.03%) | |
Self-pay | 63,859 (3.96%) | 1788 (3.85%) | |
HOSPITAL DIVISION (%) | <0.001 | ||
New England | 60,956 (3.78%) | 1904 (4.1%) | |
Middle Atlantic | 235,762 (14.62%) | 6627 (14.27%) | |
East North Central | 248,824 (15.43%) | 8972 (19.32%) | |
West North Central | 108,044.2 (6.7%) | 3864 (8.32%) | |
South Atlantic | 323,488 (20.06%) | 9362 (20.61%) | |
East South Central | 108,205 (6.71%) | 3144 (6.77%) | |
West South Central | 232,376 (14.41%) | 5224 (11.25%) | |
Mountain | 111,269 (6.9%) | 3334 (7.18%) | |
Pacific | 183,675 (11.39%) | 3799 (8.18%) | |
HOSPITAL BEDSIZE (%) | <0.001 | ||
Small | 393,474 (24.4%) | 10,124 (21.8%) | |
Medium | 46,733 (28.98%) | 13,570 (29.22%) | |
Large | 751,633 (46.61%) | 22,746 (48.98%) | |
HOSPTAL TEACHING STATUS (%) | <0.001 | ||
Rural | 158,196 (9.81%) | 4458 (9.6%) | |
Urban non-teaching | 301,556 (18.7%) | 7950 (17.12%) | |
Urban teaching | 1,152,848 (71.49%) | 34,031 (73.28%) | |
COMORBIDITIES (%) | |||
CAD | 291,236 (18.06%) | 6715 (14.46%) | <0.001 |
CHF | 283,818 (17.6%) | 7611 (16.39%) | 0.002 |
HTN uncomplicated | 613,594(38.05%) | 18,952 (40.81%) | <0.001 |
HTN complicated | 438,788 (27.21%) | 10,110 (21.77%) | <0.001 |
DM uncomplicated | 238,181 (14.77%) | 6362 (13.7%) | 0.004 |
DM complicated | 426,694 (26.46%) | 10,509 (22.63%) | <0.001 |
Renal failure | 342,194 (21.22%) | 6827 (14.7%) | <0.001 |
Chronic pulmonary disease | 354,933 (22.01%) | 10,040 (21.62%) | 0.38 |
Obesity | 412,342 (25.57%) | 12,961 (27.91%) | <0.001 |
Smoking | 412,664 (25.59%) | 12,014 (25.87%) | 0.56 |
Characteristics | COVID-19 without Pulmonary Embolism | COVID-19 with Pulmonary Embolism | p Value |
---|---|---|---|
PE (83,950) | n = 41,975 | n = 41,975 | |
SEX (Female) | 17,684 (42.13%) | 17,684 (42.18%) | 0.95 |
Mean age years (SD) | 64.50 (13.99) | 64.45 (14.03) | 0.87 |
AGE GROUPS (%) | 0.97 | ||
≥18–29 | 940 (2.24%) | 978 (2.33%) | |
30–49 | 6170 (14.70%) | 6149 (14.65%) | |
50–69 | 17,835 (42.49%) | 17,856 (42.54%) | |
≥70 | 17,029 (40.57%) | 16,991 (40.48%) | |
RACE (%) | 0.99 | ||
Caucasians | 22,641 (53.94%) | 2267 (54.02%) | |
African American | 9684 (23.07%) | 9696 (23.10%) | |
Hispanics | 6804 (16.21%) | 6833 (16.28%) | |
Asian or Pacific Islander | 995 (2.37%) | 949 (2.26%) | |
Native American | 332 (0.79%) | 294 (0.70%) | |
Others | 1519 (3.62%) | 1524 (3.63%) | |
MEDIAN HOUSEHOLD INCOME (%) | 1 | ||
<49,999$ | 13,810 (32.90%) | 13,801 (32.88%) | |
50,000–64,999$ | 11,690 (27.85%) | 11,711 (27.90%) | |
65,000–85,999$ | 9390 (22.37%) | 9394 (22.38%) | |
>86,000$ | 7085 (16.88%) | 7069 (16.84%) | |
INSURANCE STATUS (%) | 0.99 | ||
Medicare | 21,638 (51.55%) | 21,621 (51.51%) | |
Medicaid | 5293 (12.61%) | 5327 (12.69%) | |
Private | 13,436 (32.01%) | 13,461 (32.07%) | |
Self-pay | 1603 (3.82%) | 1570 (3.74%) | |
HOSPITAL DIVISION (%) | <0.001 | ||
New England | 1742 (4.15%) | 24,329 (57.96%) | |
Middle Atlantic | 6271 (14.94%) | 15,606 (37.18%) | |
East North Central | 8370 (19.94%) | 1184 (2.82%) | |
West North Central | 3077 (7.33%) | 218 (0.52%) | |
South Atlantic | 8525 (20.31%) | 365 (0.87%) | |
East South Central | 2909 (6.93%) | 504 (1.20%) | |
West South Central | 4596 (10.95%) | 101 (0.24%) | |
Mountain | 3026 (7.21%) | 109 (0.26%) | |
Pacific | 3463 (8.25%) | 55 (0.13%) | |
HOSPITAL BEDSIZE (%) | <0.001 | ||
Small | 9134 (21.76%) | 12,836 (30.58%) | |
Medium | 12,265 (29.22%) | 13,969 (33.28%) | |
Large | 20,576 (49.02%) | 15,170 (36.14%) | |
HOSPTAL TEACHING STATUS (%) | <0.001 | ||
Rural | 3874 (9.23%) | 1943 (4.63%) | |
Urban non-teaching | 7312 (17.42%) | 4814 (11.47%) | |
Urban teaching | 30,789 (73.35%) | 35,217 (83.90%) |
Variable | COVID-19 with Pulmonary Embolism | COVID-19 without Pulmonary Embolism | p Value |
---|---|---|---|
Disposition | <0.001 | ||
Home/Routine | 26,076 (56.15%) | 986,750 (61.19%) | |
SNF/LTAC/Nursing home | 11,020 (23.73%) | 357,191 (22.15%) | |
Home health | 9019 (19.42%) | 246,566.54 (15.29%) | |
AMA | 325 (0.7%) | 22,093 (1.37%) | |
Vasopressor use | 2508 (5.4%) | 41,444 (2.57%) | |
Adjusted odds ratio 1 1.62 (95% CI 1.45–1.81) | <0.001 | ||
Mechanical ventilation | 11,926 (25.68%) | 251,888 (15.62%) | |
Adjusted odds ratio 1 1.44 (95% CI 1.36–1.52) | <0.001 | ||
Sudden Cardiac Arrest | 2322 (5%) | 43,056 (2.67%) | <0.001 |
Adjusted odds ratio 1 1.53 (95% CI 1.38–1.70) | |||
Cardiogenic Shock (%) | 827 (1.78%) | 9514 (0.59%) | |
Adjusted odds ratio 1 2.15 (95% CI 1.80–2.57) | <0.001 | ||
Mechanical Circulatory Support (%) (LVAD or pVAD or ECMO) | 385 (0.83%) | 4193 (0.26%) | |
Adjusted odds ratio 1 2.03 (95% CI 1.53–2.69) | <0.001 | ||
In-hospital mortality (n = 222,490) (%) | 8935 (19.24%) | 213,555 (13.25%) | |
Adjusted odds ratio 1 1.36 (95% CI 1.28–1.45) | <0.001 | ||
Mean total hospitalization charge ($) | 143,996$ | 90,337$ | |
Adjusted total charge 1 38,907$ higher | <0.001 | ||
Mean length of stay (days) | 10.8 (10.5–11.1) | 7.9 (7.8–8.0) | |
Adjusted length of stay 1 1.9 day higher | <0.001 |
Variable | COVID-19 with Pulmonary Embolism | COVID-19 without Pulmonary Embolism | p Value |
---|---|---|---|
Total died (222,490) | 8935 | 213,555 | |
SEX (%) | <0.001 | ||
Male | 5663 (63.38%) | 124,417 (58.%) | |
Female | 3272 (36.62%) | 89,138 (41.7%) | |
AGE GROUPS (%) | |||
≥18–29 | 70 (0.78%) | 1260 (0.59%) | 0.30 |
30–49 | 730 (8.17%) | 10,251 (4.8%) | <0.001 |
50–69 | 3527 (39.47%) | 64,387 (30.1%) | <0.001 |
≥70 | 4608 (51.57%) | 137,658 (64.%) | <0.001 |
RACE (%) | |||
Caucasians | 4273 (47.82%) | 110,280 (51.%) | 0.004 |
African American | 1661 (18.59%) | 35,877 (16.8%) | 0.05 |
Hispanics | 1876 (21%) | 41,707 (19.5%) | 0.19 |
Asian or Pacific Islander | 240 (2.69%) | 7218 (3.38%) | 0.13 |
Native American | 130 (1.46%) | 2584 (1.21%) | 0.41 |
Others | 385 (4.31%) | 9418 (4.41%) | 0.85 |
HOSPTAL TEACHING STATUS (%) | |||
Rural | 566 (6.33%) | 16,849 (7.89%) | 0.03 |
Urban non-teaching | 1316 (14.73%) | 38,162 (17.8%) | 0.002 |
Urban teaching | 7054 (78.95%) | 158,565 (74%) | <0.001 |
Variable | COVID-19 with Pulmonary Embolism | COVID-19 without Pulmonary Embolism | p Value |
---|---|---|---|
Disposition | <0.001 | ||
Home/Routine | 23,141 (55.13%) | 22,138 (52.74%) | |
SNF/LTAC/Nursing home | 10,238 (24.39%) | 10,892 (25.95%) | |
Home health | 8303 (19.78%) | 8370 (19.94%) | |
AMA | 298 (0.71%) | 575 (1.37%) | |
Vasopressor use (%) | 2246 (5.35%) | 1587 (3.78%) | |
Adjusted odds ratio 1 1.79 (95% CI 1.41–2.28) | <0.001 | ||
Mechanical ventilation (%) | 10,569 (25.18%) | 6834 (16.28%) | |
Adjusted odds ratio 1 1.55 (95% CI 1.36–1.76) | <0.001 | ||
Sudden Cardiac Arrest (%) | 2099 (5%) | 1007 (2.4%) | |
Adjusted odds ratio 1 1.44 (95% CI 1.11–1.88) | 0.006 | ||
Cardiogenic Shock (%) | 756 (1.8%) | 252 (0.6%) | |
Adjusted odds ratio 1 3.1 (95% CI 2.02–4.75) | <0.001 | ||
Mechanical Circulatory Support (%) (LVAD or pVAD or ECMO) | 344 (0.82%) | 126 (0.3%) | |
Adjusted odds ratio 1 3.1 (95% CI 1.67–5.76) | <0.001 | ||
In-hospital mortality (%) (n = 13,865) | 8014 (19.09%) | 5851 (13.94%) | |
Adjusted odds ratio 1 1.29 (95% CI 1.13–1.47) | <0.001 | ||
Mean total hospitalization charge ($) | 143,705$ | 78,407$ | |
Adjusted total charge 1 52,024$ higher | <0.001 | ||
Mean length of stay (days) | 10.8 | 8.4 | |
Adjusted length of stay 1 2.3 day higher | <0.001 |
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Nasrullah, A.; Gangu, K.; Shumway, N.B.; Cannon, H.R.; Garg, I.; Shuja, H.; Bobba, A.; Chourasia, P.; Sheikh, A.B.; Shekhar, R. COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample. Vaccines 2022, 10, 2104. https://doi.org/10.3390/vaccines10122104
Nasrullah A, Gangu K, Shumway NB, Cannon HR, Garg I, Shuja H, Bobba A, Chourasia P, Sheikh AB, Shekhar R. COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample. Vaccines. 2022; 10(12):2104. https://doi.org/10.3390/vaccines10122104
Chicago/Turabian StyleNasrullah, Adeel, Karthik Gangu, Nichole B. Shumway, Harmon R. Cannon, Ishan Garg, Hina Shuja, Aniesh Bobba, Prabal Chourasia, Abu Baker Sheikh, and Rahul Shekhar. 2022. "COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample" Vaccines 10, no. 12: 2104. https://doi.org/10.3390/vaccines10122104
APA StyleNasrullah, A., Gangu, K., Shumway, N. B., Cannon, H. R., Garg, I., Shuja, H., Bobba, A., Chourasia, P., Sheikh, A. B., & Shekhar, R. (2022). COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample. Vaccines, 10(12), 2104. https://doi.org/10.3390/vaccines10122104