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

Abstract

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.

Health inequities and socioeconomic factors predicting the access to treatment for unruptured intracranial aneurysms in the USA in the last 20 years: interaction effect of race, gender, and insurance

“…However, in the adjusted models, the logical assumption that socioeconomic status serves as a proxy to insurance and further acts as a barrier to access to treatment was proven in our study (OR 1.041, 95% CI 1.035 to 1.047, p<0.001). A recent study on the surveillance of thoracic aortic aneurysms reported that people with lower socioeconomic status have a lower likelihood of referral to specialist care and are less likely to get timely follow-up imaging 21. Our findings mirror the prior studies on racial and health inequities in UIA 8–11…”

A Patient-Specific Morphoelastic Growth Model of Aortic Dissection Evolution

“…This would allow one to predict if a surgical operation may be successful at any arbitrary time point. Geometric characterization on predicted future geometries is an especially important application given the lack of consensus in the clnical literature on timing of CTA imaging for TBAD, as well as the limitations in obtaining frequent imaging due to poor patient compliance and socioeconomic barriers [41, 42].…”