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. 2023 Apr;77(4):1077-1086.e2.
doi: 10.1016/j.jvs.2022.10.048. Epub 2022 Nov 5.

The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management

Lucas Mota  1 , Christina L Marcaccio  1 , Priya B Patel  1 , Peter A Soden  2 , Carla C Moreira  2 , Lars Stangenberg  1 , Kakra Hughes  3 , Marc L Schermerhorn  4
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The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management

Lucas Mota et al. J Vasc Surg. 2023 Apr.

Abstract

Objective: Recent studies have highlighted socioeconomic disparities in the severity and management of abdominal aortic aneurysm (AAA) disease. However, these studies focus on individual measures of social disadvantage such as income and insurance status. The area deprivation index (ADI), a validated measure of neighborhood deprivation, provides a more comprehensive assessment of social disadvantage. Therefore, we examined the impact of ADI on AAA severity and its management.

Methods: We identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An ADI score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation. Patients were categorized by ADI quintiles. Outcomes of interest included rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Logistic regression was used to evaluate for an independent association between ADI quintile and these outcomes.

Results: Among 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%; P < .001). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%; P < .001). There was an overall trend toward increasing rAAA and decreasing EVAR rates with increasing ADI quintiles (P < .001). In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair (odds ratio, 1.4; 95% confidence interval, 1.2-1.8; P < .001) and lower odds of undergoing EVAR (odds ratio, 0.54; 95% confidence interval, 0.45-0.65; P < .001).

Conclusions: Among patients who underwent AAA repair in the Vascular Quality Initiative, those with higher neighborhood deprivation had significantly higher rates of rAAA repair (vs intact repair) and lower rates of EVAR (vs open approach). Further work is needed to better understand neighborhood factors that are contributing to these disparities to identify community-level targets for improvement.

Keywords: AAA; Aneurysm; Area deprivation index; Disadvantage; Disparity; Equity; Neighborhood; VQI.

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Figures

Figure 1.
Figure 1.
Proportion of patients undergoing rupture repair (vs intact repair) and EVAR (vs open approach) among ADI quintiles in the VQI between 2003–2020. * p values referent to Cuzick’s trend test.
Figure 2.
Figure 2.
Rate of EVAR stratified by repair urgency among ADI quintiles in the VQI between 2003–2020. * p values referent to Cuzick’s trend test.
Figure 3.
Figure 3.
Rate of EVAR stratified by center EVAR volume among ADI quintiles in the VQI between 2003–2020. * p values referent to Cuzick’s trend test.
See this image and copyright information in PMC

References

    1. Nguyen LL, Henry AJ. Disparities in vascular surgery: is it biology or environment? J Vasc Surg. 2010; 51:36–41. - PMC - PubMed
    1. Henry AJ, Hevelone ND, Belkin M, Nguyen LL. Socioeconomic and Hospital-Related Predictors of Amputation for Critical Limb Ischemia. J Vasc Surg, 2011; 53:330–339. - PMC - PubMed
    1. Ultee KH, Bastos Gonçalves F, Hoeks SE, Rouwet EV, Boersma E, Stolker RJ, et al. Low Socioeconomic Status is an Independent Risk Factor for Survival After Abdominal Aortic Aneurysm Repair and Open Surgery for Peripheral Artery Disease. Eur J Vasc Endovasc Surg. 2015;50(5):615–622. - PubMed
    1. Zommorodi S, Leander K, Roy J, Steuer J, Hultgren R. Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome. J Epidemiol Community Health. 2018;72(10):904–910. - PubMed
    1. Soden PA, Zettervall SL, Deery SE, Hughes K, Stoner MC, Goodney PP, et al. Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention. J Vasc Surg. 2018;67(2):549–556.e3. - PMC - PubMed

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