Socioeconomic disparities affect survival after aortic dissection
Kabbani LS, Wasilenko S, Nypaver TJ, Weaver MR, Taylor AR, Abdul-Nour K, Borgi J, Shepard AD. Socioeconomic disparities affect survival after aortic dissection. J Vasc Surg. 2016 Nov;64(5):1239-1245.
Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
OBJECTIVE: The effect of socioeconomic status (SES) on the course of many disease states has been documented in the literature but has not been studied in aortic dissection. This study evaluated the effect of SES on 30-day and long-term survival of patients after aortic dissection.
METHODS: Hospital discharge records were used to identify patients with acute aortic dissection. Patient demographics, insurance status, comorbidities, and 30-day mortality were collected. Home addresses were used to estimate each patient's median household income, and the neighborhood deprivation index, a measure of SES, was determined. Long-term survival was assessed by review of the Social Security Death Index. Associations between demographics, insurance status, comorbidities, and poverty level were investigated to determine their effect on survival.
RESULTS: There were 212 aortic dissections; of which, 118 were type A and 94 were type B. Median follow-up was 7.6 years. The neighborhood deprivation index (hazard ratio, 1.43; 95% confidence interval, 1.16-1.78; P = .001) was associated with reduced long-term survival and was also significantly associated with 30-day mortality (hazard ratio, 1.43; 95% confidence interval, 1.05-1.93; P = .02). The mean neighborhood deprivation index score was higher in patients with type B aortic dissections (0.45 ± 0.93) than in those with type A aortic dissections (0.16 ± 0.96; P = .029).
CONCLUSIONS: Patients with a lower SES had reduced short-term and long-term survival after aortic dissection. Patients with type B dissection live in lower socioeconomic neighborhoods than patients with type A dissection.
Medical Subject Headings
Acute Disease; Adult; Aged; Aneurysm, Dissecting; Aortic Aneurysm; Comorbidity; Female; Health Status Disparities; Healthcare Disparities; Humans; Income; Insurance, Health; Kaplan-Meier Estimate; Male; Michigan; Middle Aged; Patient Discharge; Poverty; Registries; Residence Characteristics; Retrospective Studies; Risk Factors; Socioeconomic Factors; Time Factors; Treatment Outcome