Differential presentation in acuity and outcomes based on socioeconomic status in patients who undergo thoracoabdominal aortic aneurysm repair

Chatterjee, Subhasis; LeMaire, Scott A.; Amarasekara, Hiruni S.; Green, Susan Y.; Wei, Qi; Zhang, Qianzi; Price, Matt D.; Jesudasen, Sirus; Woodside, Sandra J.; Preventza, Ourania; Coselli, Joseph S.

doi:10.1016/j.jtcvs.2020.07.073

Cited by 16 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with TAA, it has been observed that lower SES and lack of health insurance is associated with greater acuity of presentation and higher mortality after aortic events (dissection and rupture) 12 . However, it is unknown how SES affects the follow‐up care and progression of TAAs before this 12–14 . Better characterizing this relationship may provide important insights into how socioeconomic inequality ultimately manifests as health outcome disparities for TAA patients.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm

Shang

Weininger

Mori

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background Thoracic aortic aneurysm (TAA) is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status (SES) and surveillance practices in patients with ascending aortic aneurysms. Methods We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013 and 2016 with ascending aortic aneurysm ≥4 cm on computed tomography scans. Primary outcomes were clinical follow‐up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing SES at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death before follow up with a cardiovascular specialist. Results Lower SES was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest SES had lower hazard of follow‐up with a cardiologist or cardiac surgeon before death (hazard ratio: 0.46 [0.34, 0.62], p < .001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs. 23%–38%, p < .001). Conclusion Patients with lower SES receive less timely follow‐up imaging and specialist referral for TAAs, resulting in surgical intervention only when alarming symptoms are already present.

show abstract

Section: Introductionmentioning

confidence: 99%

Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm

Shang

Weininger

Mori

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…A recently published study on CABGs performed within a single health system in the United States indicated socioeconomic deprivation was significantly associated with operative mortality, however, these results were not replicated in a separate study looking at thoracoabdominal aneurysm repair. 3,4 Beliaev provide an excellent international comparison for which future research into socioeconomic deprivation in the United States can be compared. It could be argued Beliaev et al have provided evidence that universal coverage creates more equitable outcomes among patients undergoing cardiac surgery, however, international comparisons are certainly nuanced with many assumptions to be made.…”

Section: Socioeconomic Deprivation Among Cardiac Surgery Patients In Thementioning

confidence: 99%

“…Socioeconomic deprivation among cardiac surgery patients in the United States has caught the attention of the cardiac surgery community. A recently published study on CABGs performed within a single health system in the United States indicated socioeconomic deprivation was significantly associated with operative mortality, however, these results were not replicated in a separate study looking at thoracoabdominal aneurysm repair 3,4 . Beliaev provide an excellent international comparison for which future research into socioeconomic deprivation in the United States can be compared.…”

mentioning

confidence: 98%

Surgery for aortic dissection: An international case for universal coverage?

2021

View full text Add to dashboard Cite

“…20,24 Prior to this, the understanding of how socioeconomic barriers impact outcomes in patients with TAA was limited to only to survival after aortic dissection. 13,14 This catastrophic outcome is avoidable with periodic monitoring and elective intervention.…”

Section: Commentmentioning

confidence: 99%

“…12 However, it is unknown how SES affects the follow-up care and progression of TAAs prior to this. [12][13][14] Better characterizing this relationship may provide important insights into how socioeconomic inequality ultimately manifests as health outcome disparities for TAA patients. In the present study, we utilized the area deprivation index (ADI) as a measure of SES, which uses national census data to calculate a percentile measure of socioeconomic deprivation within in each census-block group.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Shang

Weininger

Mori

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Thoracic aortic aneurysm is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status and surveillance practices in patients with ascending aortic aneurysms. Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013-2016 with ascending aortic aneurysm ≥4cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing socioeconomic status at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death prior to follow up with a cardiovascular specialist. Results: Lower socioeconomic status was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest socioeconomic status had lower hazard of follow-up with a cardiologist or cardiac surgeon prior to death (HR 0.46 [0.34, 0.62], p<0.001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs 23-38%, p<0.001). Conclusion: Patients with lower socioeconomic status receive less timely follow-up imaging and specialist referral for thoracic aortic aneurysms, resulting in surgical intervention only when alarming symptoms are already present.

show abstract

Differential presentation in acuity and outcomes based on socioeconomic status in patients who undergo thoracoabdominal aortic aneurysm repair

Cited by 16 publications

References 30 publications

Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm

Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm

Surgery for aortic dissection: An international case for universal coverage?

Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

Contact Info

Product

Resources

About