Socioeconomic Factors Linked to Treatment Delays in Veterans with PAH

Mature Asian doctor talks with armed forces veteran during evaluation. The veteran is sitting in a wheelchair. Only his back is seen in the photo. The doctor is wearing a lab coat and is holding the patient’s medical file.
Are delays in treatment for pulmonary arterial hypertension the cause of the poorer PAH outcomes seen among individuals in socially disadvantaged groups?

Veterans with PAH generally experienced clinically meaningful treatment delays, with greater treatment delays seen in those with lower incomes and without insurance, according to study results recently presented at the American Thoracic Society (ATS) International Conference 2022, held in San Francisco, CA, May 13 to 18.

“Individuals with PAH belonging to socially disadvantaged groups including racial minorities and those with lower socioeconomic status (SES) experience worse outcomes,” noted study authors, who therefore sought to assess whether these poor outcomes resulted from delays in receiving treatment. The researchers also assessed the association various socioeconomic factors — including race/ethnicity, income, and homelessness — and treatment delays in PAH.

The investigators conducted a retrospective cohort study of all adult veterans with PAH between 2006 and 2019 (n=1827; 27% Black, 4% Hispanic; 22.1% with yearly income less than $20,000; 53.3% uninsured; 25.5% with less than a high school education; 3.9% homeless), identifying participants who had been treated with 1 or more pulmonary vasodilators. Cox proportional hazard models were used to calculate time-to-treatment.

For all participants, from diagnosis to treatment, median time was 114 days (IQR 21-336). Increased time-to-treatment was seen comparing individuals with incomes below $20,000 vs those with incomes above $99,999 (HR 0.74; 95% CI, 0.60-0.91) and for those lacking health insurance (HR 0.90; 95% CI, 0.81-1.00). There was no association between time-to-treatment and race/ethnicity, education, or homelessness.

Researchers concluded that, “Veterans with PAH experienced delays in treatment, with median time-to-treatment of more than 16 weeks after diagnosis, a clinically meaningful delay that is associated with poor outcomes,” and that “even greater delays in treatment initiation” were experienced by those lacking health insurance or with lower annual incomes.


Gillmeyer KR, Rinne ST, Qian SX, et al. Socioeconomic status is associated with treatment delays in pulmonary arterial hypertension. Presented at: the American Thoracic Society (ATS) 2022 Annual Meeting; May 13-18, 2022; San Francisco, CA. Abstract