Studies have demonstrated that low socioeconomic status, insurance, and race impact clinical outcomes in patients with abdominal aortic aneurysms. The purpose of this study was to assess if living in high-poverty areas, insurance, and race impact clinical outcomes in patients diagnosed with thoracoabdominal aortic aneurysm (TAAA). We conducted a retrospective review of patients with TAAAs confirmed by computed tomography imaging between 2009 and 2019 at a single institution. Patients’ zip codes were mapped to American Community Survey Data to obtain geographic poverty rates. We used the standard US Census definition of high poverty concentration, as >20% of the population was living at 100% of the poverty rate. Our primary outcome was overall survival, stratified by whether or not the patient underwent repair. We also assessed if poverty concentration and distance influenced repair rates. Of 578 patients, 575 had zip code data and were analyzed. In both the nonoperative (N = 258) and repair (N = 311) groups, there were no significant differences in age, race, or comorbidities between patients living in high-poverty areas (N = 95, 16.4%) vs not. In the nonoperative group, patients from high-poverty areas were more likely to have aneurysm due to dissection (37.5 vs 17.6%, P = .03). In multivariate analyses, patients from high-poverty zip codes had significantly worse overall survival (hazard ratio [HR]: 1.9, 95% confidence interval: 1.1-3.3; P = .03). In the repair group, high poverty was also a significant predictor of reduced postoperative survival (HR: 1.65, 95% confidence interval: 1-2.63; P = .04) (Fig 1). Private insurance was predictive of improved postoperative survival (HR: 0.42, 95% confidence interval: 0.18-0.95; P = .04). These results were found after adjusting for age, race, sex, maximum aortic diameter, coronary artery disease, distance from the hospital, insurance status, and active smoking. There were insufficient data to determine if race impacted survival discretely from poverty status. Interestingly, traveling greater than 100 miles improved long-term survival (HR: 0.61, 95% confidence interval: 0.41-0.92, P = .02) (Table). In multivariate regression, patients living over 100 miles from the hospital were significantly more likely to undergo repair (odds ratio: 1.58, 95% confidence interval: 1.08-2.33; P = .02). There was no significant difference in surgery utilization based on poverty adjusting for the same factors. This study demonstrates socioeconomic disparities in TAAA survival. Patients with TAAA living in high-poverty areas had significantly more dissections and suffered a nearly doubled risk of mortality compared with patients living outside such areas. This study highlights the pressing need for further research into TAAA disparities.TableVariables predictive of survival for patients with TAAAHazard ratio95% confidence intervalP valueNonoperative group (overall survival) High poverty1.901.103.27.021 Distance to hospital over 100 miles0.560.370.83.004 InsuranceMedicareReferent11Medicaid1.290.562.97.54Private2.051.014.14.044Operative repair group (postoperative survival to 5 years) High poverty1.651.02.63.036 Distance to hospital over 100 miles0.610.410.92.017 InsuranceMedicareReferent11Medicaid0.740.321.68.47Private0.420.180.95.037TAAA, Thoracoabdominal aortic aneurysm.Elevated hazard ratio indicates increased risk of mortality. Open table in a new tab