Abstract Rationale Diagnostic delay in pulmonary hypertension (PH) worsens risk at presentation and outcomes, yet how race, place, and social determinants of health (SDoH) shape time-to-diagnosis remains incompletely synthesized. Contemporary guidance emphasizes timely right-heart catheterization (RHC) and early referral, which may be unevenly accessible across communities. Methods Following PRISMA, we searched MEDLINE, Embase, Web of Science, and Scopus (Jan-2020-Oct-2025) for cohort/registry/population studies reporting: (a) time from symptom onset/first encounter to PH/PAH diagnosis or RHC; and/or (b) race/ethnicity, geography (rurality/region), or SDoH associations with diagnostic timing, severity at diagnosis, or early outcomes. Two reviewers screened, extracted, and quality-rated; heterogeneity in delay definitions precluded meta-analysis, so we used structured narrative synthesis and vote-counting of direction of effect. Results Twenty-four studies met criteria. Patient-reported and cohort data show substantial diagnostic lag, ranging from medians ∼3 months to 1 year; patient-reported delays up to ∼17 months persist despite increased awareness. Rurality and regional factors correlate with higher PH mortality and variation in presentation, consistent with structural access barriers and travel burdens. SDoH (insurance, income, education, neighborhood deprivation) independently associate with worse functional class/severity at diagnosis and outcomes, including in PHAR-based analyses; adjusting for SDoH attenuates some ethnicity effects. Multiple U.S. studies report that Black (and in some cohorts Hispanic) patients present with greater severity at first specialty assessment, even within accredited-center cohorts; direct race-stratified time-to-diagnosis data remain sparse—a key evidence gap. Conclusions Since 2020, evidence demonstrates meaningful diagnostic delays in PH and consistent associations between geography/SDoH and severity at diagnosis. Race-linked disparities appear to operate largely via contextual disadvantage and access, not biology. Standardized reporting of time-to-RHC and race/SDoH-stratified diagnostic intervals should be required in registries and quality programs to close the “geography of delay.” This abstract is funded by: None
Rivas et al. (2026) studied this question.