US study highlights racial and ethnic disparities in the placement of “overused” IVC filters

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A nationwide US study, recently published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders (JVS-VL), showed that Black patients had the highest inferior vena cava (IVC) filter placement rate per 100,000 persons compared with white and Latino patients in the USA from 2016 to 2019.

“Given the known long-term complications and uncertain benefits of IVC filters, coupled with the 2010 US Food and Drug Administration [FDA] 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,” authors Jordan J Juarez (Philadelphia, USA) and colleagues remark.

Juarez, a medical student at Lewis Katz School of Medicine at Temple University, et al detail that they performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal lower extremity deep vein thrombosis (DVT) from January 2016 to December 2019, including self-reported patient race and ethnicity.

The authors note that weighted multivariable logistic regression was used to compare IVC filter use by race and ethnicity. The regression model was adjusted for patient demographics, hospital information, weekend admission, and clinical characteristics.

Juarez and colleagues report in JVS-VL that, of 134,499 acute proximal lower extremity DVT patients included in the review, 18,909 (14.1%) received an IVC filter. Of the patients who received an IVC filter, 12,733 were white (67.3%), 3,563 were Black (18.8%), and 1,679 were Latino (8.95%). They relay that IVC filter placement decreased for all patient groups between 2016 and 2019.

After adjusting for the US population distribution, the investigators explain that the IVC filter placement rates were 11 to 12 per 100,000 persons for Black patients, seven to eight/100,000 persons for white patients, and four to five/100,000 persons for Latino patients. They share that the difference in IVC filter placement rates was statistically significant between patient groups (Black patients versus white patients, p<0.05; Black patients versus Latino patients, p<0.05; Latino patients versus white patients, p<0.05).

In discusssing their findings, Juarez et al look into possible reasons behind the uncovered disparities. “Although the reasons behind this racial and ethnic disparity need further investigation,” they write, “factors such as clinician bias related to concern for medication adherence could play a role.”

The authors also consider their results more generally in the context of IVC filter usage in the USA. They point to previously reported literature showing an implantation rate much higher in the USA than in Europe (three per 100,000 persons based on data from five large European countries). Against this background, they comment that higher placement rates in the Black community are “especially concerning” and “suggest that IVC filters are still overused in the USA”.

Focusing next on some of the limitations of their research, Juarez and colleagues underscore the possibility of unmeasured confounders not assessed and adjusted for in their multivariable regression analysis, among others.

“Future work should assess whether clinical bias for adherence to other treatments could be perpetuating this disparity in minoritized communities,” the authors write as a forward-looking concluding remark.


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