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Sociodemographic Profiles Affecting Presentation, Therapy and Mortality Of Patients Diagnosed With Abdominal Aorta Aneurysms (AAA) In Urban Hospitals (1998-2002)

Introduction and Objectives:
Under-diagnosis or lack of appropriate treatment in patients with intact and often asymptomatic abdominal aorta aneurysm (AAA) may lead to mortality when these patients present with signs and symptoms of ruptured AAA. This study was performed to establish sociodemographic profiles that may lead to disparities of presentation, treatment and mortality of patients with AAA.
Methods:
Using ICD-9 codes, the Nationwide Inpatient Sample database was searched to identify patients presenting to urban hospitals with the primary diagnosis of intact (iAAA) or ruptured/dissecting AAA (rAAA). Univariate and muliple logistic regression analyses of sociodemographic variables were performed.
Results:
251,275 AAA admissions were identified with 180,602 AAA repair during the study period; 152,656 were repaired open (OAR) and 27,946 endovascularly (EVAR). RAAA was more common in the older patients (74.3 vs. 72.4 years; p< .0001). Adjusted for covariates, rAAA was also more common in females (OR 1.3, 95% CI 1.2-1.4, p< .0001), non-white patients (OR 1.5, 95% CI 1.3-1.6, p< .0001), and Medicaid recipients (OR 2.1 95% CI 1.8-2.5, p< .0001). Of those presenting with iAAA, OAR was more frequently performed on females (OR 1.5, 95% CI 1.4-1.7, p< .0001), obese (OR 1.7, 95% CI, 1.4-2.0, p< .0001) and patients from lower average income ZIP codes (p< .0001). Adjusted in-hospital mortality rate was found to be higher in females (OR 1.5, 95% CI 1.3-1.7, p<. 0001), and Medicaid beneficiaries (OR 1.8 95%CI 1.3-2.5, p= .0051). Mortality rate was higher among those treated with OAR (compared to EVAR) or presented with r AAA (p< .0001).
Conclusions:
Sociodemographic factors may lead to disparity of presentation, therapy and subsequent mortality rate of AAA. These disparities may stem from the lack of access to the adequate primary care or from delayed referral to a vascular surgeon.