Racial and Ethnic Disparities in Patients With Ruptured Abdominal Aortic Aneurysm

Abstract

The incidence of abdominal aortic aneurysm (AAA) continues to rise, and high morbidity and mortality exist among patients with ruptured AAA (rAAA). Therefore, screening and prevention are critical. Previous studies suggest that clinical presentation and treatment modalities for intact AAA vary among racial groups. The aim of our study was to assess racial and ethnic disparities in patients with rAAA. We performed a 2-year (2015-2016) retrospective analysis of the National Surgical Quality Improvement Program database including all patients with AAA undergoing surgical intervention. Patients were stratified as ruptured and nonruptured and on the basis of race and ethnicity. The primary outcomes were racial and ethnic disparities on presentation and in-hospital patient outcomes. Missing variable analysis was performed. Regression analysis was performed to assess outcome measures. A total of 7043 patients with AAA were included, of which 14% (n = 986) were rAAA; 18.7% (n = 1317) were open repair. African Americans (P = .01) and Hispanics (P = .04) were more likely to present with rupture, whereas whites were less likely to present with rupture (P = .01). There was no difference in open or endovascular treatment between racial and ethnic groups. The Fig demonstrates racial and ethnic distribution among patients. The Table demonstrates factors associated with presentation with rupture. Among rAAAs, African Americans were more likely to have complications (1.18 [1.02-3.7]; P = .04) and higher mortality (1.15 [1.05-4.2]; P = .048). Hispanics were more likely to have complications after intervention for rAAA (1.12 [1.09-2.5]; P = .036). However, there was no difference in mortality. There are racial and ethnic disparities among patients with AAA during initial presentation (intact vs ruptured) and in outcomes after intervention for rAAA. African American were 18% more likely and Hispanics were 8% more likely to present with rAAA. African Americans and Hispanics had a higher complication rate after intervention for rAAA. In our study, there was no difference in treatment modality offered. Further studies are warranted to help better understand the reasons for potential disparities in AAA screening and prevention of rupture among different racial and ethnic groups to provide effective and equitable health care to prevent a vascular emergency such as rAAA.TableFactors associated with presentation as ruptureaCharacteristicsOR [95%]P valueAfrican American1.18 [1.05 - 3.05].045Hispanics1.08 [1.04 - 4.2].04aControIIing for age, gender comorbidities, transfer status, type of hospital, insurance, Ethnicity. Open table in a new tab