Ethnic disparities among patients with pulmonary hypertension associated with systemic sclerosis.
OBJECTIVE
To examine a cohort of patients with systemic sclerosis (SSc) and pulmonary hypertension (PH) for ethnic disparities in clinical presentation, disease detection, or management.


METHODS
Encounters of patients with SSc seen at the Medical University of South Carolina were recorded in a computerized database from November 1997 through January 2004. Patients were evaluated for discrepancy in disease manifestation and treatment. Evaluation criteria included patient ethnicity (by self report), age, disease duration from onset of first non-Raynaud's symptom, presence or absence of PH, incidence of diastolic dysfunction and left ventricular hypertrophy among patients with PH, severity of interstitial lung disease, and treatment course.


RESULTS
African Americans were more likely than Caucasians to have diffuse cutaneous SSc (dcSSc) (69.9% vs 42.9%, p < 0.001) and they presented with PH (defined as right ventricular systolic pressure > 40 mm Hg by echocardiogram or mean pulmonary artery pressure > 25 mm Hg by right heart catheterization (RHC) at a younger age (60.9 yrs vs 49.0 yrs, p < 0.001). There were no ethnic disparities in time from onset of the first non-Raynaud's symptom to detection of PH, method of PH detection, or treatment modalities. Patients with PH were more likely to have diastolic dysfunction than those without PH (52.3% vs 35.9%, p = 0.011).


CONCLUSIONS
In this cohort of patients, African Americans were more likely to have dcSSc. Among patients with PH, African Americans presented at a younger age than their Caucasian counterparts. Incidence of diastolic dysfunction was higher in the PH population. There were no significant ethnic disparities in time of progression to PH or in treatment modalities employed in our cohort.
Beall
Ashley D
AD
Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina 29425-2229, USA. beall@musc.edu
Nietert
Paul J
PJ
Taylor
Marian H
MH
Mitchell
Holly C
HC
Shaftman
Stephanie R
SR
Silver
Richard M
RM
Smith
Edwin A
EA
Bolster
Marcy B
MB
D000328:Adult; D001741:Black or African American / Q000208:ethnology; D000367:Age Factors; D000368:Aged; D044383:Black People / Q000208:ethnology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000208:ethnology* / Q000209:etiology*; D017379:Hypertrophy, Left Ventricular / Q000208:ethnology / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000208:ethnology*; D044465:White People / Q000208:ethnology