The Differentiation of Etiologies of Pulmonary Arterial Hypertension amongst Males and Females

Abstract

There are limited studies which have studied the etiological differentiation of pulmonary arterial hypertension in large patient sample. To understand the association pattern of etiologies of pulmonary arterial hypertension. The National Inpatient Sample (NIS) was used to identify all patients 18 years and older hospitalized in 2016 with primary or secondary diagnosis of pulmonary arterial hypertension (PAH) by ICD-10 code I270. We then sought to differentiate etiologies of PAH among males and females. We looked for difference in relative risk profile, geographical distribution and outcomes including length of stay (LOS), mortality, Elixhauser mortality score and readmission score. Categorical variables were assessed with Chi square testing and continuous variables with two sample t-tests. Analyses were conducted using SAS v 9.4. A total of 10,300 patients with primary or secondary diagnosis of pulmonary arterial hypertension were identified, of which 31% were males and 69% females. This distribution was observed across the US (Figure 1A). In terms of prevalence, men were primarily in the Mountain states, whereas women were primarily in the Pacific states (Figure 1B/C). Males were more likely to have HIV related pulmonary hypertension (0.78% vs 0.14%, p=0.0208), whereas females were more likely to have scleroderma related pulmonary hypertension (1.1% vs 4.08%, p=0.0003). Males were likely to have atrial fibrillation (37.25% vs 32.29%, p=0.0316), coronary artery disease (43.51% vs 27.25%, p < 0.0001), smoking (35.68% vs 25.85%, p < 0.0001), and sleep apnea (26.29% vs 21.55%, p=0.0181), relative to females. There were no significant differences in relation to LOS, total hospital charges, mortality or readmission. Pulmonary arterial hypertension in males was more likely to be associated with HIV, coronary artery disease, atrial fibrillation, sleep apnea and smoking whereas among females, it was more likely to be associated with scleroderma.