A systematic review with meta-analysis on racial and ethnic disparities in acute venous thromboembolism diagnosis and management.

OBJECTIVE

Acute venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is one of the leading causes of cardiovascular mortality. Recent studies have shown racial and ethnic disparities in VTE incidence and outcomes. The objective of this review is to identify racial and ethnic disparities present in the incidence, diagnosis, and management of VTE.

METHODS

A comprehensive review was conducted in PubMed and ScienceDirect using the following search terms: pulmonary embolism, deep vein thrombosis, race, ethnicity, racial disparities, ethnic disparities, and social determinants. Papers were included if they were published in English and within the years 2004 to 2024. Papers were excluded if they studied non-United States adult populations, if VTE was not a main outcome of interest, or if they focused on surgery or COVID-related VTE. The resultant papers (n = 52) included randomized clinical trials, systematic reviews, meta-analyses, and observational studies at single-center, multi-center, and national levels. Quantitative data on the use of catheter-based therapies (CBTs) by racial and ethnic groups were extracted from a subsect of papers where it was explicitly reported (n = 8). Using this data, a meta-analysis was conducted to compare the utilization of CBTs for pulmonary embolism across different racial and ethnic groups.

RESULTS

Significant racial and ethnic disparities in the diagnosis and treatment of VTE were noted. Black patients had the highest disease incidence, severity, mortality, and inpatient complications. Similar inequities may exist among other racial and ethnic groups, although these remain less well-characterized due to limited ethnic representation in current VTE literature and related clinical trials. Genetic factors contribute more to VTE risk in White patients, whereas comorbidities and socioeconomic disparities have a more significant impact on non-White patients. Several studies have noted disparities in access to catheter-directed thrombolysis for non-White patients compared with White patients. Notably, racial disparities in advanced therapy usage are reduced in the context of high-risk pulmonary embolism, though ethnic disparities persist. Initial studies have suggested that Pulmonary Embolism Response Team implementation may reduce disparities in VTE management, though further research is needed to evaluate its impact on outcomes. Results of the meta-analysis further supported these findings by revealing increased CBT usage in White and non-Hispanic patients compared with Black and Hispanic patients, respectively.

CONCLUSIONS

Socioeconomic vulnerability and comorbid conditions account for disparities in VTE incidence in minority populations, and poor outcomes in these groups may be tied to inequalities in access to catheter-based interventions.